Therapy Switching, Augmentation, and Discontinuation in Patients with Osteoarthritis and Chronic Low Back Pain

Gore, Mugdha; Sadosky, Alesia; Leslie, Douglas L.; Tai, Kei Sing; Emery, Paul

doi:10.1111/j.1533-2500.2011.00524.x

Cited by 37 publications

(37 citation statements)

References 38 publications

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“…First, prescription NSAIDs likely improve patient‐reported outcomes only during active treatment. Discontinuation rates of prescription NSAIDs have been reported to exceed 85% within 6 months of initiation , with time‐to‐discontinuation being slightly longer for those initiating COX inhibitors . If the timing of the assessments of patient‐reported outcomes was months after discontinuation, our study would have underestimated the short‐term beneficial effects of prescription NSAIDs.…”

Section: Discussionmentioning

confidence: 99%

Effects of Prescription Nonsteroidal Antiinflammatory Drugs on Symptoms and Disease Progression Among Patients With Knee Osteoarthritis

Lapane

Yang

Driban

et al. 2015

Arthritis & Rheumatology

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Objective The effect of short and long term non-steroidal anti-inflammatory agents (NSAIDs) use on structural change is equivocal. We estimate the extent to which recent and long-term use of prescription NSAIDs relieve symptoms and delay structural progression among patients with radiographically confirmed osteoarthritis (OA) of the knee. Methods We applied a new-user design among participants with confirmed OA not reporting NSAID use at enrollment in the Osteoarthritis Initiative. Participants were evaluated for changes in the Western Ontario and McMaster Universities Arthritis Index, WOMAC (n=1,846) and joint space width measured using serial x-rays and a customized software tool (n=1,116) over 4 years. We used marginal structural modeling to estimate the effect of NSAIDs. Results Compared to participants who never reported prescription NSAID use, those reporting use at 1 or 2 assessments had no clinically important changes, but those reporting prescription NSAID use on all 3 assessments had on average 0.88 point improvement over the follow-up period (95% Confidence Interval (CI): -0.46 to 2.22) in Pain, 0.72 point improvement (95% CI: -0.12 to 1.56) in Stiffness, 4.27 points improvement (95% CI: -0.31 to 8.84) in Function, and decreased by 0.28mm in joint space width (95% CI: -0.06 to 0.62) less than no use. Recent NSAID use findings were not clinically or statistically significant. Conclusions Long term but not recent NSAID use was associated with a priori defined minimally important clinical change in stiffness, function and structural change but not in pain. While showing modest clinical importance, estimates did not reach statistical significance.

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Section: Discussionmentioning

confidence: 99%

Effects of Prescription Nonsteroidal Antiinflammatory Drugs on Symptoms and Disease Progression Among Patients With Knee Osteoarthritis

Lapane

Yang

Driban

et al. 2015

Arthritis & Rheumatology

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“…All patients with chronic musculoskeletal pain were routinely switching medication every 12 months [11][12][13]. Of these, 99 patients receiving daily NSAIDs during the rst 12 months followed by receiving daily TA combination tablets for 12 months were analyzed in this study.…”

Section: Subjectsmentioning

confidence: 99%

“…Taken together, these studies show that regular administration of NSAIDs results in chronic renal failure [7], but patients taking NSAIDs for 6 weeks or less may have a chance of recovery [10]. Based on the potentially intolerable side effects or suboptimal pain relief, substantial proportions of musculoskeletal pain patients are often switched to a different treatment within 12 months of initiating NSAID treatment [11][12][13]. However, no study to date has evaluated the potential safety bene t of this common practice: reversing renal side effects following cessation of long-term NSAID therapy.…”

Section: Introductionmentioning

confidence: 99%

Impact of nonsteroidal anti-inflammatory drug administration for 12 months on renal function

Hayashi

Miki²,

Kajiyama

et al. 2020

Preprint

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Background: The use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with an increased risk of renal complications. Resolution of renal side effects following NSAID administration has been observed following short-term use. Thus, the aim of the present study was to investigate whether switching from long-term NSAID administration to tramadol hydrochloride/acetaminophen (TA) combination tablets results in reversal of renal side effects.Methods: This was a longitudinal retrospective study of 99 patients with chronic musculoskeletal pain. The patients were administrated NSAIDs daily during the first 12 months followed by daily TA combination tablets for 12 months. Estimated glomerular filtration rate (eGFR) and serum levels of aspartate aminotransferase and alanine transaminase were measured at baseline, after NSAIDs administration, and after TA administration.Results: eGFR was significantly reduced following 12-month NSAIDs administration (median, from 84.0 mL/min/1.73 m2 to 72.8 mL/min/1.73 m2), and further reduction was prevented following the subsequent 12-month TA administration. Reduction in eGFR was less in patients who received celecoxib (median, -1.8 mL/min/1.73 m2) during the first 12 months. There was no significant difference in aspartate aminotransferase and alanine transaminase in each period.Conclusions: Thus, patients receiving NSAIDs for 12 months displayed both reversible and irreversible reduction of eGFR upon cessation of NSAIDs and switching to TA. Our data highlights the potential safety benefit of utilizing multimodal analgesic therapies to minimize the chronic administration of NSAIDs.

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“…[9], которые изучали практику применения анальгетиков (парацетамол, НПВП, трамадол, «слабые» и «сильные» опиоиды) у пациентов с ОА и БНЧС. Оказалось, что в течение 1-го месяца лечения назначенные лекарства по разным причинам (неэффективность, нежелательные явления и др.)…”

Section: эффективное купирование боли -необходимый элемент комплексноunclassified

Aceclofenac in rheumatology: The golden mean

Каратеев¹

2013

Modern Rheumatology Journal

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В XXI в. основным инструментом лечения ревматиче-ских заболеваний (РЗ) является целенаправленная патоге-нетическая терапия. Использование высокотехнологич-ных лекарственных средств (таких, как генно-инженер-ные биологические препараты), воздействующих на клю-чевые элементы развития болезни, позволяет добиться максимального замедления темпов ее прогрессирования или ремиссии. Но даже самые действенные и современ-ные лекарства не могут обеспечить терапевтический успех у всех больных, к тому же во многих случаях для достиже-ния стойкого улучшения требуется длительное время. По-этому ревматологу нередко приходится возвращаться к «старым добрым» симптоматическим средствам, которые облегчают страдания больного, хотя и не влияют на разви-тие заболевания [1-4].Речь идет прежде всего об анальгетиках. Не вызывает сомнений, что боль является основным и наиболее тяго-стным проявлением хронических заболеваний суставов и позвоночника, которое определяет тяжесть страданий, функциональные нарушения и ухудшение социального положения пациента. В то же время хроническая боль оценивается сегодня как самостоятельная и весьма серь-езная угроза жизни больного. Хроническая боль приво-дит к нарушениям гомеостаза, опосредованным реакцией симпатоадреналовой системы -повышением артериаль-ного давления, частоты сердечных сокращений и актива-цией тромбоцитов. Суммарно, это определяет существен-ное нарастание частоты осложнений со стороны сердеч-но-сосудистой системы (ССС), способных привести к ле-тальному исходу [1,4]. Эффективное купирование боли -необходимый элемент комплексной терапии ревматических заболеваний (РЗ). Центральное ме-сто среди анальгетиков занимают нестероидные противовоспалительные препараты (НПВП

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Therapy Switching, Augmentation, and Discontinuation in Patients with Osteoarthritis and Chronic Low Back Pain

Abstract: This study demonstrates that therapy switching and discontinuation of select pain medications were common among OA and CLBP patients in the U.K. and may result from inadequate pain relief or undesirable side effects.

Cited by 37 publications

References 38 publications

Effects of Prescription Nonsteroidal Antiinflammatory Drugs on Symptoms and Disease Progression Among Patients With Knee Osteoarthritis

Effects of Prescription Nonsteroidal Antiinflammatory Drugs on Symptoms and Disease Progression Among Patients With Knee Osteoarthritis

Impact of nonsteroidal anti-inflammatory drug administration for 12 months on renal function

Aceclofenac in rheumatology: The golden mean

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