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BMJ (Clinical Research Ed.) Jan 1998To review the effectiveness and safety of topical non-steroidal anti-inflammatory drugs in acute and chronic pain conditions. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To review the effectiveness and safety of topical non-steroidal anti-inflammatory drugs in acute and chronic pain conditions.
DESIGN
Quantitative systematic review of randomised controlled trials.
DATA SOURCES
86 trials involving 10,160 patients.
MAIN OUTCOME MEASURES
Measures of treatment success approximating at least 50% reduction in pain, local and systemic adverse effects. Analysis at 1 week for acute and 2 weeks for chronic conditions with relative benefit and number needed to treat.
RESULTS
In acute pain conditions (soft tissue trauma, strains, and sprains) placebo controlled trials had a relative benefit of 1.7 (1.5 to 1.9), the number needed to treat was 3.9 (3.4 to 4.4). With analysis by drug (at least three trials), ketoprofen (number needed to treat 2.6), felbinac (3.0), ibuprofen (3.5), and piroxicam (4.2) had significant efficacy. Benzydamine and indomethacin were no different from placebo. In chronic pain conditions (osteoarthritis, tendinitis) placebo controlled trials had a relative benefit of 2.0 (1.5 to 2.7); the number needed to treat was 3.1 (2.7 to 3.8). Small trials (< 40 treated patients) exaggerated effectiveness of topical non-steroidals by 33% in acute conditions but not in chronic conditions. There was no relation between trial quality and treatment effect. In both acute and chronic pain local and systemic adverse events and withdrawal from the study related to the drug had a low incidence and were no different from placebo.
CONCLUSION
Topical non-steroidal anti-inflammatory drugs are effective in relieving pain in acute and chronic conditions.
Topics: Acute Disease; Administration, Topical; Anti-Inflammatory Agents, Non-Steroidal; Chronic Disease; Drug Combinations; Humans; Pain; Randomized Controlled Trials as Topic; Sprains and Strains; Treatment Outcome
PubMed: 9487165
DOI: 10.1136/bmj.316.7128.333 -
BMJ (Clinical Research Ed.) Jun 1996To compare the relative risks of serious gastrointestinal complications reported with individual non-steroidal anti-inflammatory drugs. (Comparative Study)
Comparative Study Meta-Analysis
OBJECTIVE
To compare the relative risks of serious gastrointestinal complications reported with individual non-steroidal anti-inflammatory drugs.
DESIGN
Systematic review of controlled epidemiological studies that found a relation between use of the drugs and admission to hospital for haemorrhage or perforation.
SETTING
Hospital and community based case-control and cohort studies.
MAIN OUTCOME MEASURES
(a) Estimated relative risks of gastrointestinal complications with use of individual drugs, exposure to ibuprofen being used as reference; (b) a ranking that best summarised the sequence of relative risks observed in the studies.
RESULTS
12 studies met the inclusion criteria. 11 provided comparative data on ibuprofen and other drugs. Ibuprofen ranked lowest or equal lowest for risk in 10 of the 11 studies. Pooled relative risks calculated with exposure to ibuprofen used as reference were all significantly greater than 1.0 (interval of point estimates 1.6 to 9.2). Overall, ibuprofen was associated with the lowest relative risk, followed by diclofenac. Azapropazone, tolmetin, ketoprofen, and piroxicam ranked highest for risk and indomethacin, naproxen, sulindac, and aspirin occupied intermediate positions. Higher doses of ibuprofen were associated with relative risks similar to those with naproxen and indomethacin.
CONCLUSIONS
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. In higher doses ibuprofen is associated with a similar risk to other non-steroidal anti-inflammatory drugs. Use of low risk drugs in low dosage as first line treatment would substantially reduce the morbidity and mortality due to serious gastrointestinal toxicity from these drugs.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Case-Control Studies; Cohort Studies; Dose-Response Relationship, Drug; Gastrointestinal Hemorrhage; Hospitalization; Humans; Ibuprofen; Intestinal Perforation; Risk
PubMed: 8664664
DOI: 10.1136/bmj.312.7046.1563