Comparison of naproxen and acetaminophen in a two‐year study of treatment of osteoarthritis of the knee

Williams, H. James; Ward, John; Egger, Marlene J.; Neuner, Rosemarie; Brooks, Raye H.; Clegg, Daniel O.; Field, Elizabeth H.; Skosey, John L.; Alarcón, Graciela S.; Willkens, Robert F.; Paulus, Harold E.; Russell, I. Jon; Sharp, John T.

doi:10.1002/art.1780360904

Cited by 238 publications

(113 citation statements)

References 24 publications

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“…In studies on which the ACR guidelines were based, dosages over 2,600 mg/day were not included (32), while other studies that did investigate higher doses (4,000 mg/day) demonstrated similar levels of subjective symptoms of gastric discomfort between ketoprofen and acetaminophen (10) and similar adverse events between ibuprofen and acetaminophen (18). Several randomized controlled trials and epidemiologic studies have demonstrated an increase in rates of dyspepsia in patients who took acetaminophen (15,17), and some epidemiologic studies showed a significant association between acetaminophen intake and gastric ulcers (14,33).…”

Section: Discussionmentioning

confidence: 99%

Determinants and sequelae associated with utilization of acetaminophen versus traditional nonsteroidal antiinflammatory drugs in an elderly population

Rahme

Pettitt

LeLorier

2002

Arthritis & Rheumatism

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Objective. Acetaminophen is recommended as initial therapy for patients with arthritis, particularly those at increased risk of nonsteroidal antiinflammatory drug (NSAID)-induced gastrointestinal (GI) side effects. However, higher doses of acetaminophen inhibit prostaglandin synthesis and have been associated with GI events. This study was undertaken to compare the observed and adjusted rates of GI events (hospitalizations, ulcers, dyspepsia, GI prophylaxis) occurring with higher versus lower doses of acetaminophen.Methods. This was a retrospective cohort study of subjects ages >65 years who received a prescription for acetaminophen or NSAID between 1994 and 1996. Pharmaceutical and medical records were reviewed for 1 year of historical data prior to the index prescription of acetaminophen or non-aspirin NSAID. Risk factors for GI events were identified based on the historical data. To further control for bias, patients were categorized by propensity score (the likelihood of receiving acetaminophen, given defined risk factor values). Records were then reviewed for the duration of the index prescription or 30 days, whichever was less, to generate data on the occurrence of GI events. Determinants of acetaminophen utilization were identified using logistic regression, and rates of GI events for each therapy were examined using Poisson regression analyses, controlling for duration of exposure, individual risk factors, and propensity scores.Results. . Unadjusted rates of GI hospitalization, ulcer, and dyspepsia were higher for patients in the acetaminophen cohort than for those in the NSAID cohort. The occurrence of GI events in acetaminophen-treated patients was dose dependent, with rate ratios (compared with high-dose NSAIDs and adjusted for risk susceptibility) ranging from 0.6 (95% confidence interval 0.5-0.7) for <650 mg/day to 1.0 (0.9-1.1) for >3,250 mg/day.Conclusion. In this cohort, acetaminophen utilization is more common in patients at higher risk of GI events. After adjustment for risk susceptibility, patients receiving higher doses of acetaminophen have higher rates of GI events compared with those receiving lower doses.Practice guidelines endorsed by the American College of Rheumatology (ACR) recommend acetaminophen (up to 4 gm/day) as initial therapy for the treatment of arthritis (1,2), to avoid the gastrointestinal (GI) toxicity attributable to conventional nonsteroidal antiinflammatory drugs (NSAIDs) (3-9). Acetaminophen can also be used for patients with a history of NSAID intolerance or GI disease. (1,2,10) Recognized risk factors for GI events include age Ͼ65 years, previous GI disease, concomitant use of corticosteroids or anticoagulants, and comorbidities (3,8,9,11,12).However, several studies have associated acetaminophen with increased dyspepsia (13-15), and at Supported by Pfizer Inc.

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Section: Discussionmentioning

confidence: 99%

Determinants and sequelae associated with utilization of acetaminophen versus traditional nonsteroidal antiinflammatory drugs in an elderly population

Rahme

Pettitt

LeLorier

2002

Arthritis & Rheumatism

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“…Initially it was designed to measure walking function in patients with musculoskeletal disorders including osteoarthritis (27,28), rheumatoid arthritis (29,30), low back pain (31,32), and geriatric (aging) conditions (33,34). In these circumstances, factors such as joint swelling, stiffness, and inflammation effect walking speed.…”

Section: -Foot Walk Testmentioning

confidence: 99%

“…Like other timed distance tests, patients must be able to complete the 50-foot distance in order to participate in the test. Normative data exist in the literature for osteoarthritis and rheumatoid arthritis (27)(28)(29)(30).…”

Section: -Foot Walk Testmentioning

confidence: 99%

Outcome Measures for Gait and Ambulation in the Spinal Cord Injury Population

Jackson

Carnel

Ditunno

et al. 2008

The Journal of Spinal Cord Medicine

162

130

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FIM-L).Methods: A subcommittee of international experts evaluated each instrument for test construct, administration, population applicability, reliability, sensitivity to change, and validity. Evaluations for each outcome measure were compiled, distributed to the whole committee, and then further reviewed with addition of comments and recommendations for consensus. An audience of experts voted on the validity and usefulness of each measure. Results: WISCI II and 10MWT were found to be the most valid and clinically useful tests to measure improvement in gait for patients with SCI. FIM-L had little utility and validity for research in SCI. 6MWT and 50FTWT were found to be useful but in need of further validation or changes for the SCI population. Conclusion: A combination of the 10MWT and WISCI II would provide the most valid measure of improvement in gait and ambulation in as much as objective changes of speed, and functional capacity allow for interval measurement. To provide the most comprehensive battery, however, it will be important to include a measure of endurance such as the 6MWT. Further validation and study should be devoted to WISCI II, 10MWT, and 6MWT as primary outcome measures for gait in SCI.

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“…17,18 However, it can be seen from the Oxford League Table that overall, NSAIDs are clearly more efficacious than acetaminophen. A recent survey of 1799 patients with osteoarthritis found that the majority (>60%) preferred NSAIDs over acetaminophen in the symptomatic treatment of osteoarthritis based on perceived better efficacy.…”

Section: Comparison Of the Efficacy Of Nsaids With Other Analgesicsmentioning

confidence: 99%

An Evidence-Based Update on Nonsteroidal Anti-Inflammatory Drugs

Ong¹,

Lirk²,

Tan³

et al. 2007

Clinical Medicine & Research

491

286

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Nonsteroidal anti-inflammatory drugs (NSAIDs), including both traditional nonselective NSAIDs and the selective cyclooxygenase (COX)-2 inhibitors, are widely used for their anti-inflammatory and analgesic effects. NSAIDs are a necessary choice in pain management because of the integrated role of the COX pathway in the generation of inflammation and in the biochemical recognition of pain. This group of drugs has recently come under scrutiny because of recent focus in the literature on the various adverse effects that can occur when applying NSAIDs.This review will provide an educational update on the current evidence of the efficacy and adverse effects of NSAIDs. It aims to answer the following questions: (1) are there clinically important differences in the efficacy and safety between the different NSAIDs, (2) if there are differences, which are the ones that are more effective and associated with fewer adverse effects, and (3) which are the effective therapeutic approaches that could reduce the adverse effects of NSAIDs. Finally, an algorithm is proposed which delineates a general decision-making tree to select the most appropriate analgesic for an individual patient based on the evidence reviewed. Keywords: Analgesics; COX-2 specific inhibitors; NSAIDs; Pain Nonst eroidal anti-inflammatory drugs (NSAIDs) are among the most widely used medications in the world because of their demonstrated efficacy in reducing pain and inflammation. 1 Their efficacy has been documented in a number of clinical disorders, including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, gout, dysmenorrhea, dental pain and headache. [2][3][4][5][6][7][8] The basic mode of action is inhibition of the pro-inflammatory enzyme cyclooxygenase (COX). NSAIDs as a class comprise both traditional nonselective NSAIDs (tNSAIDs) that nonspecifically inhibit both COX-1 and COX-2, and selective COX-2 inhibitors. Although effective at relieving pain and inflammation, tNSAIDs are associated with a significant risk of serious gastrointestinal adverse events with chronic use. 9 Therefore, specific inhibitors of the COX-2 isoenzyme were developed, thus opening the possibility to provide antiinflammatory and analgesic benefits, while theoretically leaving the gastroprotective activity of the COX-1 isoenzyme intact. However, important concerns have recently been raised regarding the potential cardiovascular toxicity of COX-2 inhibitors. 10This review will provide an educational update of the scientific evidence for the efficacy and adverse effects of NSAIDs in view of the emerging new information for this class of drugs. It is composed deliberately to be a classic, pragmatic review and draws on the results of published systematic reviews and studies regarding the topic. It aims to answer the following questions: (1) are there clinically important differences in the efficacy and safety between the different NSAIDs, (2) if there are differences, which are the ones that are more effective and associated with fewer adverse effects, and (3) which are...

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Comparison of naproxen and acetaminophen in a two‐year study of treatment of osteoarthritis of the knee

Abstract: The efficacy of ACT treatment and NPX treatment was similar, although it was slightly better for NPX. The toxicity rate was slightly lower with ACT. However, the high rate of withdrawal in both treatment groups suggests that neither is satisfactory for the treatment of OA.

Cited by 238 publications

References 24 publications

Determinants and sequelae associated with utilization of acetaminophen versus traditional nonsteroidal antiinflammatory drugs in an elderly population

Determinants and sequelae associated with utilization of acetaminophen versus traditional nonsteroidal antiinflammatory drugs in an elderly population

Outcome Measures for Gait and Ambulation in the Spinal Cord Injury Population

An Evidence-Based Update on Nonsteroidal Anti-Inflammatory Drugs

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