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Efficacy and Safety of Oral Nsaids and Analgesics in the Management of Osteoarthritis: Evidence from Real-Life Setting Trials and Surveys

Efficacy and Safety of Oral Nsaids and Analgesics in the Management of Osteoarthritis: Evidence from Real-Life Setting Trials and Surveys
Efficacy and Safety of Oral Nsaids and Analgesics in the Management of Osteoarthritis: Evidence from Real-Life Setting Trials and Surveys
Non-steroidal anti-inflammatory drugs (NSAIDs) are at the cornerstone of treatment for osteoarthritis (OA). In recent years, the widespread use of oral NSAIDs has been called into question due to the appearance of significant upper gastrointestinal (GI) complications and cardiovascular (CV) adverse events (AEs). However, NSAIDs are non-homogeneous, and there are noticeable differences between them in AE risk for GI and CV events. Nevertheless, if properly prescribed oral NSAIDs can provide an effective and safe treatment for OA in real-life situations. The identification of patients with significant CV and/or GI risk is critical, and the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) treatment algorithm provides guidance on appropriate treatments for OA patients with elevated risk. Among non-selective NSAIDs, ibuprofen and naproxen seem preferable to diclofenac, the latter being associated with higher CV risk. Recommendation has been made by some that naproxen may be the preferred agent in patients at high CV risk because of its lower risk of CV events. Low dose celecoxib (200 mg/day) is also associated with a lower risk of CV events compared with other coxibs. In addition, drugs with a demonstrated low GI risk profile may be of benefit, such as coxibs and nabumetone. Among patients who fail to respond adequately to sequential ESCEO algorithm Step 1 and Step 2 treatments, the short-term use of weak opioids, such as tramadol, for severely symptomatic OA patients is recommended. Although studies exploring the efficacy of tramadol in OA are limited, there is good evidence that tramadol works if prescribed properly. The sustained-release (SR) formulation of tramadol is preferred as it avoids the peak plasma concentrations reached with immediate-release tramadol, which is believed to reduce the incidence of AEs. Furthermore, slow upwards titration of tramadol SR is recommended to improve tolerability and minimize treatment discontinuations.
analgesics, coxibs, cyclo-oxygenase-2 (COX-2) inhibitors, knee osteoarthritis, oral non-steroidal anti-inflammatory drugs (NSAIDs), tramadol
0049-0172
1-6
Pelletier, Jean-Pierre
bed7c601-ce19-4804-8781-d27f674ccccb
Martel-Pelletier, Johanne
fdcae9e5-239c-430f-a971-a287f7a0645e
Rannou, François
3ced5c61-ef3e-48c0-99ff-6f50a820ac51
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Pelletier, Jean-Pierre
bed7c601-ce19-4804-8781-d27f674ccccb
Martel-Pelletier, Johanne
fdcae9e5-239c-430f-a971-a287f7a0645e
Rannou, François
3ced5c61-ef3e-48c0-99ff-6f50a820ac51
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6

Pelletier, Jean-Pierre, Martel-Pelletier, Johanne, Rannou, François and Cooper, Cyrus (2015) Efficacy and Safety of Oral Nsaids and Analgesics in the Management of Osteoarthritis: Evidence from Real-Life Setting Trials and Surveys. Seminars in Arthritis and Rheumatism, 1-6. (doi:10.1016/j.semarthrit.2015.11.009).

Record type: Article

Abstract

Non-steroidal anti-inflammatory drugs (NSAIDs) are at the cornerstone of treatment for osteoarthritis (OA). In recent years, the widespread use of oral NSAIDs has been called into question due to the appearance of significant upper gastrointestinal (GI) complications and cardiovascular (CV) adverse events (AEs). However, NSAIDs are non-homogeneous, and there are noticeable differences between them in AE risk for GI and CV events. Nevertheless, if properly prescribed oral NSAIDs can provide an effective and safe treatment for OA in real-life situations. The identification of patients with significant CV and/or GI risk is critical, and the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) treatment algorithm provides guidance on appropriate treatments for OA patients with elevated risk. Among non-selective NSAIDs, ibuprofen and naproxen seem preferable to diclofenac, the latter being associated with higher CV risk. Recommendation has been made by some that naproxen may be the preferred agent in patients at high CV risk because of its lower risk of CV events. Low dose celecoxib (200 mg/day) is also associated with a lower risk of CV events compared with other coxibs. In addition, drugs with a demonstrated low GI risk profile may be of benefit, such as coxibs and nabumetone. Among patients who fail to respond adequately to sequential ESCEO algorithm Step 1 and Step 2 treatments, the short-term use of weak opioids, such as tramadol, for severely symptomatic OA patients is recommended. Although studies exploring the efficacy of tramadol in OA are limited, there is good evidence that tramadol works if prescribed properly. The sustained-release (SR) formulation of tramadol is preferred as it avoids the peak plasma concentrations reached with immediate-release tramadol, which is believed to reduce the incidence of AEs. Furthermore, slow upwards titration of tramadol SR is recommended to improve tolerability and minimize treatment discontinuations.

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e-pub ahead of print date: 2 December 2015
Keywords: analgesics, coxibs, cyclo-oxygenase-2 (COX-2) inhibitors, knee osteoarthritis, oral non-steroidal anti-inflammatory drugs (NSAIDs), tramadol
Organisations: Human Development & Health

Identifiers

Local EPrints ID: 385608
URI: http://eprints.soton.ac.uk/id/eprint/385608
ISSN: 0049-0172
PURE UUID: 714fa288-ae1e-443e-bfe7-ff11d63dfe97
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 19 Jan 2016 17:01
Last modified: 18 Mar 2024 02:45

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Contributors

Author: Jean-Pierre Pelletier
Author: Johanne Martel-Pelletier
Author: François Rannou
Author: Cyrus Cooper ORCID iD

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