Perspectives of Healthcare Professionals Towards Combination Use of Oral Paracetamol and Topical Non-Steroidal Inflammatory Drugs in Managing Mild-to-Moderate Pain for Osteoarthritis in a Clinical Setting: An Exploratory Study

Abstract

Purpose To seek indicative evidence on clinical prescription practice and perspectives regarding combined oral paracetamol (APAP) and/or topical non-steroidal anti-inflammatory drugs (NSAIDs) therapy for managing mild-to-moderate osteoarthritis (OA) pain. Participants and Methods An exploratory qualitative study to investigate the perspectives towards using APAP and/or topical NSAIDs for OA pain management and whether current clinical practices are aligned with OA guidelines was conducted using a two-round modified Delphi methodology among three general practitioners, three orthopedists, and two pharmacists from Australia, Malaysia, and Sweden during January–June 2021. In the first round, 60-minute virtual in-depth interviews were conducted individually; in the second round, summary of the key findings was shared with the panel to seek clarity on the level of consensus (≥70% unanimity) and disagreement. Results The healthcare professionals (HCPs) agreed that APAP was considered as a universally accepted pharmacologic for most OA patients except those with contraindications or allergies. Consensus was achieved towards APAP combination with topical NSAIDs being a safer alternative than with oral NSAIDs. However, prescription uptake of combined therapy APAP with topical NSAIDs was low among the panel due to lack of strong scientific evidence on efficacy and awareness. Differences in clinical practice across and within countries could be due to different reference sources for OA pain – clinical practice experience or local/international guidelines/medical products handbooks. Conclusion The study suggests an opportunity to raise awareness of the suitability and potential benefits for adjuvant topical NSAIDs to APAP for effective OA pain management as well as a need for universal OA guidelines.

Novel poly(lactic-co-glycolic acid) nanoliposome-encapsulated diclofenac sodium and celecoxib enable long-lasting synergistic treatment of osteoarthritis

“…Combination therapy has a synergistic effect, and compared with the administration of two drugs alone, the combination of two drugs can effectively enhance the efficacy of the drug and reduce the side effects of the drug. 10,11 Therefore, in order to improve the efficacy of intra-articular injection administration, it is a feasible strategy to make extendedrelease formulations of multiple anti-inflammatory drugs by encapsulating them in nanocarriers to achieve long-lasting synergistic treatment of the drugs. 12 Extended-release formulations can significantly improve the pharmacokinetic and pharmacodynamic properties of drugs, which can sustain the release of active drug molecules, avoid the peak phenomenon of blood concentration in the body to protect the gastrointestinal and renal organs, and thus improve patient compliance and therapeutic efficacy, which has gained great research interest in drug development.…”

“…Combination therapy has a synergistic effect, and compared with the administration of two drugs alone, the combination of two drugs can effectively enhance the efficacy of the drug and reduce the side effects of the drug. 10,11 Therefore, in order to improve the efficacy of intra-articular injection administration, it is a feasible strategy to make extended-release formulations of multiple anti-inflammatory drugs by encapsulating them in nanocarriers to achieve long-lasting synergistic treatment of the drugs. 12…”