Double-blind Cross-over Study of Ketoprofen and Ibuprofen in Management of Rheumatoid Arthritis

Mills, S. B.; Bloch, Mark; Bruckner, F E

doi:10.1136/bmj.4.5884.82

Cited by 41 publications

(23 citation statements)

References 7 publications

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“…To the best of our knowledge this is the first report of the potential clinical and structural benefit of the use of Acthar Gel in the management of early RA References: [1] Acthar Gel Package Insert. [2] Levine, Drug Design, Development and Therapy 2012:6. Background: Corticosteroids (CS) are used on rheumatoid arthritis (RA) treatment for decades, due to their rapid and efficacious improvement of arthritis.…”

Section: Discussionmentioning

confidence: 99%

“…Emerging evidence related to the melanocortin system suggests that ACTH may have mechanisms of action in addition to steroidogenesis. (2) ACTH by virtue of inhibitory influences on cytokine action and inflammatory cell migration has been reported to be effective in multiple inflammatory disorders in humans and adrenalectomized rats (3). This may have significant relevance in the management of inflammatory disorders such as RA.…”

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confidence: 99%

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AB0504 The Role of Corticosteroids in Rheumatoid Arthritis Patients Under Biologic Therapy

Madureira¹,

Pimenta²,

Vieira³

et al. 2015

Ann Rheum Dis

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BackgroundCorticosteroids (CS) are used on rheumatoid arthritis (RA) treatment for decades, due to their rapid and efficacious improvement of arthritis. With the recent advances in RA treatment and the increasing awareness given to CS side effects it should be expected that these drugs started being used scarcely and for shorter periods of time.ObjectivesAnalyse the variations in CS dose in patients with RA after the start of biologic therapy. Analyse the existence of differences between biologics regarding CS therapy.MethodsA retrospective analysis of all patients with RA receiving biologic therapy of a rheumatology department of a Portuguese University Hospital. The demographic and clinic baseline data was collected. The variations in CS dose between baseline and 12 and 24 months were determined, as well as their difference according to the biologic agent: anti-TNF, Rituximab and Tocilizumab. Other biologics were excluded due to the small number of patients assigned to them. The proportion of patients steroid-free was determined as well as the differences according to the current biologic. All CS dose are displayed as the equivalent prednisolone doses.ResultsIn January 2015, 176 patients met the inclusion criteria; 88.3% were women, with mean age of 57.2 (±10.9) years, and disease duration of 19.8 (±9.8) years. Rheumatoid factor and/ or anti-cyclic citrullinated peptide (anti-CCP) were positive in 77.8% of patients. Mean baseline DAS28 was 6.02 (±1.41) and mean baseline HAQ was 1.80 (±0.56). Most of the patients (n=98) were treated with anti-TNF agents; 48 patients received rituximab and 30 tocilizumab.Mean CS dose at baseline was 7.02 (±4.33) mg/day; after 12 months of biologic therapy reduced to 6.29 (±3.93) mg/day (p<0.001) and after 24 months to 5.65 (±3.90) mg/day (p<0.001). With all the biologics analysed it was seen a significant reduction in steroids dose: in patients receiving anti-TNF agents mean CS dose reduced from 6.44 (±4.20) to 5.81 (±3.91) mg/day at 12 months (p=0.015) and to 5.48 (±4.01) mg/day at 24 months (p=0.002). With Rituximab it reduced from 7.74 (±4.42) to 6.55 (±3.54) at 12 months (p=0.032) and to 5.68 (±3.73) mg/day at 24 months (p=0.005); with Tocilizumab from 7.20 (±3.11) to 6.76 (±2.83) (p=0.136) and to 5.91 (±2.56) mg/day (p=0.043), respectively.We found a significant higher CS dose at 12 months of treatment in patients that switched biologic 2 or more times (7.50±4.59 mg/day) vs. patients that switched 1 time (6.23±2.65 mg/day) vs. patients that were being treated with their first biologic (6.14±4.19 mg/day) (p<0.001). The results were also significant different at 24 months.While at baseline only 8.9% of patients were steroid-free, this number increased to 10.7% at 12 months (p<0.001) and to 15.8% at 24 months (p<0.001). This effect was similar in anti-TNF agents (10.2%, 12.4% (p<0.001), 15.1% (p<0.001), respectively), Rituximab (8.3%, 10.4% (p=0.002), 20.0% (p<0.001), respectively). In tocilizumab this effect was less pronounced.ConclusionsThis analysis suggests that RA patients...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

AB0504 The Role of Corticosteroids in Rheumatoid Arthritis Patients Under Biologic Therapy

Madureira¹,

Pimenta²,

Vieira³

et al. 2015

Ann Rheum Dis

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“…In rheumatoid arthritis, double-blind within-patient trials have shown ketoprofen to have analgesic and anti-inflammatory activity greater than that of placebo (Cathcart et al, 1973;Zutshi et al, 1973) and of ibuprofen (Mills et al , 1973) and indistinguishable from that of an equal daily dose of indomethacin (Gyory et al, 1972). In patients with osteoarthrosis of the hip, the clinical efficacy of ketoprofen 100 mg daily was again indistinguishable from that of 100 mg daily of indomethacin (Gyory et al, 1972).…”

Section: Therapeutic Trialsmentioning

confidence: 99%

“…In controlled trials conducted to date comparing the therapeutic efficacy of ketoprofen with that of placebo, ibuprofen or indomethacin, each drug has been given in random order for a period of 1 (Cathcart et al, 1973) or 2 weeks (Gyory et al, 1972;Mills et al, 1973;Zutshi et al, 1973). All studies have excluded patients with renal or hepatic disease and most have also excluded those with a history of gastro-intestinal disease, as well as children, and women of childbearing age in whom the possibility of pregnancy could not be excluded.…”

Section: Controlled Trials In Rheumatoid Arthritismentioning

confidence: 99%

Ketoprofen

Brogden¹,

Speight²,

Avery³

1974

Drugs

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“…Upper abdominal pain or indigestion are the main complaints [3,4], Twenty-nine percent of the patients on NSAIDs had experienced heartburn, indigestion or sour stomach at least once within the previous week [5]. These gastrointestinal symptomatic complaints are important as they interfere with compliance and continuing use of NSAIDs.…”

Section: Introductionmentioning

confidence: 99%

Global Analysis of Gastrointestinal Safety of a New Nsaid, Meloxicam

Distel¹,

Mueller²,

Bluhmki³

1997

Side Effects of Anti-Inflammatory Drugs IV

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ABSTRACfMeloxicam is a new preferential cyclo-oxygenase-2 inhibitor. This paper presents a global safety analysis of data from meloxicam clinical studies, focusing on gastrointestinal (GI) adverse events.Meloxicam 7.5 mg and IS mg (n = 893 and 3282) were compared with piroxicam 20 mg (n = 906), diclofenac 100 mg slow release (n = 324) and naproxen 750-1000 mg (n = 243). With respect to all GI adverse events, meloxicam 7.5 mg and IS mg were significantly superior to all comparators in a pooled analysis of double-blind studies in rheumatoid arthritis and osteoarthritis. When examining nonserious GI events, severe GI events, discontinuations due to GI events, dyspepsia, abdominal pain and upper GI events, both meloxicam doses were significantly superior to comparator NSAIDs in most cases. Where statistical significance was not demonstrated, there was generally a clear trend in favour of meloxicam. With respect to upper GI perforations, ulcerations and bleedings, the most serious of NSAID-associated side-effects, meloxicam was better tolerated than the comparators, reaching statistical significance for piroxicam and naproxen. Meloxicam's improved GI safety profile is likely to be due to its preferential inhibition of inducible cyclo-oxygenase-2 relative to constitutive cyclooxygenase-I.

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Double-blind Cross-over Study of Ketoprofen and Ibuprofen in Management of Rheumatoid Arthritis

Cited by 41 publications

References 7 publications

AB0504 The Role of Corticosteroids in Rheumatoid Arthritis Patients Under Biologic Therapy

AB0504 The Role of Corticosteroids in Rheumatoid Arthritis Patients Under Biologic Therapy

Ketoprofen

Global Analysis of Gastrointestinal Safety of a New Nsaid, Meloxicam

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