Extracts from "Clinical Evidence": Non-steroidal anti-inflammatory drugs
BMJPublished 15 April 2000Open access
Peter C Gøtzsche
Citations109
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Medicine
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The demonstration that inhibition of prostaglandin synthesis via a cyclo-oxygenase (COX) enzyme was central to both the therapeutic and toxic effects of aspirin and non-aspirin NSAIDs appeared to establish the principle of no gain without pain, but this link may have been broken by drugs that selectively inhibit the inducible COX-2 enzyme.
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The low risk of serious gastrointestinal complications with ibuprofen seems to be attributable mainly to the low doses of the drug used in clinical practice, and in higher doses ib uprofen is associated with a similar risk to other non-steroidal anti-inflammatory drugs.
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Topical non-steroidal anti-inflammatory drugs are effective in relieving pain in acute and chronic conditions and their effectiveness and safety are widely thought to be ineffective, despite licensed status.
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Important design aspects were decreasingly reported in NSAID trials over the years, whereas the quality of statistical analysis improved, and it is not obvious how a reliable meta-analysis could be done in these trials.
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It was found that nonsteroidal antiinflammatory drugs shortened the time period to recovery and were associated with less pain, and studies also showed that cryotherapy was of benefit and diapulse may be helpful.
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The use of misoprostol, but not that of H2blockers, was beneficial in the prevention of NSAID-induced gastric ulcers, and misobrostol or H2blocks in the short-term prevention of duodenal ulcers remains to be confirmed.
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Ranitidine was as effective as misoprostol for the prevention of NSAID-induced duodenal ulcers and should be used for prophylaxis against both gastric and duodanal ulceration in patients on chronic NSAID therapy.
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Risk differences were pooled using the DerSimonian and Laird method, which weights studies inversely according to variance, and only the unspecified gastric symptoms for non‐aspirin non‐steroidal anti‐inflammatory drugs (NA—NSAIDs) and the haemorrhage for aspirin were found to be statistically significant.
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NSAID trials in patients with OA of the hip appear to be weakened by the lack of standardization of case definition of OA, and also by the failure to standardize of outcome assessments.
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The Medical Journal of AustraliaPattern of non‐steroidal anti‐inflammatory drug use in Australia 1990–1994 A report from the Drug Utilization Sub‐Committee of the Pharmaceutical Benefits Advisory Committee
40 Citations1996Peter McManus, John G Primrose +4 more
To determine the pattern of use of non‐steroidal anti‐inflammatory drugs (NSAIDs) in the Australian community, 1990–1994, a large number of prescriptions for NSAIDs were given to people with a history of substance abuse.
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A patient with classical rheumatoid arthritis had Proliferating granulation tissue at the elbow had entrapped and displaced the ulnar nerve, which was corrected surgically with almost complete restoration of nerve function.
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Compared to Px, Tx performs better on physician assessment of efficacy and tolerability, but the other comparisons remain inconclusive, and compared to Dcl, there appears not to be a difference.
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