Oral NSAIDs: Duration of Efficacy, Time to Adverse Event

Oral NSAIDs for Knee OA: Duration of Efficacy, Time to Adverse Event Onset Examined – by Da Hee Han, PharmD – Mar 2019

Here’s why people who have pain all the time shouldn’t be using the CDC’s recommendation to use NSAIDs instead of opioids: authors found that traditional NSAIDs were “associated with the least favorable safety profile.

A systematic review and meta-analysis published in Arthritis Care & Research aimed to assess the duration of efficacy, as well as the onset of adverse events, associated with oral nonsteroidal anti-inflammatory drugs (NSAIDS) used in the treatment of knee osteoarthritis (OA).

To investigate these outcomes, researchers conducted a literature search which identified 72 randomized controlled trials where the efficacy and safety of oral NSAIDs was examined in patients with knee OA (N=26,424).   

With regard to pain, results showed that NSAIDs provided statistically significant benefits as early as week 2 (standardized mean difference [SMD] -0.43, 95% CI, -0.48, -0.38) and lasting for up to 26 weeks, however, the effects decreased over time and lost clinical significance by 8 weeks.

Here we see the critical difference between statistical versus clinical significance.

“The results for function were similar,” the authors noted.

As for adverse events, NSAID users were more likely to experience a minor gastrointestinal adverse event as early as 4 weeks after starting treatment (relative risk [RR] 1.38, 95% CI, 1.21, 1.57).

While the risk of experiencing a minor cardiovascular event was found to be higher in NSAID users compared with placebo, this was not deemed statistically significant at any time point in the analysis.

In addition, when comparing the safety of different classes of NSAIDs, the authors found that traditional NSAIDs were “associated with the least favorable safety profile.”

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