Nonsteroidal Anti-inflammatory Drugs In Patients Research Articles

Investigation of the analgesic efficacy of local therapy with non-steroidal anti-inflammatory drugs in patients with knee osteoarthritis

Objective: to analyze the extent of analgesic effect and to determine predictors of inadequate response to local therapy with non-steroidal antiinflammatory drugs (NSAIDs) in a prospective, comparative, randomized trial of the efficacy and safety of Artoxan® gel 1% versus Diclofenac gel 1% in patients with knee OA.Material and methods. The study included 60 patients with a definite diagnosis of stage II–III Kеllgren–Lawrence knee OA who fulfilled ACR criteria and were observed on an outpatient basis in V.A. Nasonova Research Institute of Rheumatology. Patients were 40–80 years old (mean 62.50±8.04 years), body mass index (BMI) 24.9±4.67 kg/m2 , median OA duration 5.7 [3;15] years. According to the randomization scheme, the patients were divided into two groups. In the 1st group (n=30), local therapy with 1% Artoxan gel was applied to the target area of the knee twice daily for 14 days. Patients in the 2nd group (n=30) were prescribed local therapy with the comparator drug, 1% Diclofenac gel with a similar application regimen. Patients in both groups were comparable in terms of the main parameters.Results and discussion. Patients in both groups showed a significant decrease in pain intensity in the target joint during walking according to the visual analogue scale (VAS) after two weeks of treatment (p <0.05). A decrease in pain (to mild or moderate) in the target joint to <40 mm according to VAS after 7 days of therapy reported 43.3% of patients in the 1st group, and 63.3% of patients after 14 days of therapy (p=0.09). In the 2nd group, 43.3 % of patients also reported a reduction in pain in the target joint to <40 mm according to VAS after 7 days of therapy, and after 14 days it was observed in 56.7% of cases (p=0.22). Although the differences between the groups did not reach statistical significance, a reduction in pain to <40 mm according to VAS and a high BMI (r= -0.28; p=0.029).Conclusion. The results of the study demonstrate a significant analgesic effect of local NSAIDs in knee OA. In most patients, pain was <40 mm according to VAS after 2 weeks of local NSAID therapy. At the same time, there was a tendency towards a higher frequency of pain reduction to <40 mm according to VAS in the group receiving local therapy with 1% Artoxan gel. It was concluded that excessive body weight and high BMI may be predictors of inadequate analgesic effect in patients with knee OA.

Prescription of non-steroidal anti-inflammatory drugs for patients with inflammatory arthritis decreases with the initiation of tumour necrosis factor inhibitor therapy: results from the ICEBIO registry

Objective To study the impact of tumour necrosis factor-α inhibitor (TNFi) therapy on the use of non-steroidal anti inflammatory drugs (NSAIDs) in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and axial spondyloarthritis (axSpA) in Iceland. Method This registry cohort study used data from the nationwide database on biologics in Iceland (ICEBIO) and the Icelandic Prescription Medicines Register on disease activity, and filled prescriptions for NSAIDs, to study the period from 2 years before to 2 years after initiation of a first TNFi. Five randomly selected individuals from the general population matched on age, sex, and calendar time for each patient served as comparators. Results Data from 940 patients and 4700 comparators were included. Patients with arthritis were prescribed 6.7 times more defined daily doses of NSAIDs than comparators (149 vs 22 per year). After TNFi initiation, NSAID use decreased to a mean of 85 DDD per year, or by 42% in RA, 43% in PsA, and 48% in axSpA. At TNFi initiation, the quintile of axSpA patients who used most NSAIDs reported significantly worse pain (mean ± sd 66 ± 21 vs 60 ± 23 mm), global health (70 ± 20 vs 64 ± 23 mm), and Health Assessment Questionnaire score (1.21 ± 0.66 vs 1.02 ± 0.66) than the other patients, whereas no significant differences were observed in the groups with peripheral arthritis. Conclusion Patients with inflammatory arthritides requiring TNFi therapy use more NSAIDs than matched comparators, and consumption decreased following TNF initiation. Patient-reported measures are not associated with high NSAID use in patients with peripheral arthritis.

Moderators of treatment effect of non-steroidal anti-inflammatory drugs for patients with (sub) acute low back pain: Protocol for a systematic review with individual participant data meta-analysis

A Cochrane review found that non-steroidal anti-inflammatory drugs (NSAIDs) are slightly more effective than placebo on acute and subacute low back pain (LBP) outcomes (pain intensity, disability, and global improvement). Our objectives are: (1) to assess the overall treatment effect of NSAIDs in adults with acute and subacute LBP; (2) to identify the moderation of baseline patients’ characteristics on treatment effect. We will conduct a systematic search of RCTs on effectiveness of NSAIDs compared with placebo in adults with non-chronic LBP in Medline ALL, Embase, Cochrane Central Register of Controlled Trials*. We will screen the records after January 2020, and include eligible RCTs before January 2020 screened by the Cochrane review mentioned above. Our primary outcomes are pain intensity, disability, and health-related quality of life, secondary outcomes are adverse events. Our IPD dataset will consist of the information on each eligible trial characteristics and included variables according to a predefined coding scheme. We will assess risk-of-bias of included RCTs with the Cochrane Risk Of Bias (RoB)-2 assessment tool. We will perform power calculations with closed-form solutions and prioritize a one-stage approach for IPD-MA. For reporting the results, we will adhere to the PRISMA-IPD statement.

Efficiency of platelet aggregation with different sensitivity of cyclooxygenase to non-steroid anti-inflammatory drugs in patients with nephrolithiasis

Objective: to establish the dependence of thrombocyte (Tc) aggregation efficiency on crosstalk-signaling pathways associated with stimulation of TR-receptor and purine P2-receptors, with different cyclooxygenase (COX) activity against the background of non-steroidal anti-inflammatory drugs (NSAIDs) administration in patients with nephrolithiasis (NLT). Material and methods. The study was prospective and included 60 patients with NLT who received non-steroid anti-inflammatory drugs (NSAIDs) for analgesia as part of lithokinetic therapy (LKT). The cohort of patients was divided into two groups, with effective (group 1, n=30) and ineffective (group 2, n=30) COX inhibition. The activity of TP receptors, purine P2 receptors (P2X1 and P2Y receptors) of platelets was assessed on a ChronoLog analyzer (USA). Agonists (ATP, ADP and Arachidonic acid) were used at EC50 and EC10 concentrations. Results. In the 1st group, after 72 hours of LCT, the activity of the TR receptor, P2 receptors of Tc decreased to the level of hyporeacti-vity. The regulation of the compensatory reaction of Tc in response to hematuria was provided through the synergism of the P2 receptors, and the TP receptor and the P2X1 receptor. In 2nd group hyperreactivity of the TP receptor and P2 receptors persisted. Optimal modulation of the compensatory reaction of Tc was provided by the synergism of the TP receptor and P2Y receptors. Conclusion. The efficiency of Tc aggregation during NSAIDs administration is determined by intracellular signalling associated with TR receptor and P2 receptors.

The Effects of Pharmacist-Led Medication Therapy Management on Medication Adherence and Use of Non-Steroidal Anti-Inflammatory Drug in Patients with Pre-End Stage Renal Disease.

Patients with chronic kidney disease (CKD) are particularly vulnerable to the risks of polypharmacy, largely owing to various comorbid conditions. This vulnerability is further compounded by an escalated risk of renal function deterioration when exposed to nephrotoxic medications. As part of the national health insurance program in Taiwan, the pre-end-stage kidney disease patient care and education plan has included pharmaceutical care since October 2021. This study aims to explore the effect of pharmacist involvement in a multidisciplinary care team for patients with kidney disease in outpatient settings. This retrospective observational study was conducted at a single center. It analyzed data from May 2022 to May 2023, focusing on patients who received medication therapy management in the kidney disease pharmacist-managed clinic. The study assessed changes in patient medication adherence, non-steroidal anti-inflammatory drugs (NSAIDs) usage, CKD stage, and urine protein-to-creatinine ratio (UPCR) after pharmacist intervention. It also documented pharmacists' medication recommendations and the rate of acceptance by physicians. A total of 202 patients who had at least two clinic visits were included in the study. After pharmacist intervention, the proportion of poor medication adherence reduced significantly from 67.8% to 43.1% (p<0.001). The proportion of NSAID users also decreased significantly from 19.8% to 8.4% (p=0.001). CKD stage showed a significant reduction (p=0.007), and the average UPCR improved from 2828.4 to 2111.0 mg/g (p<0.001). The pharmacists provided a total of 56 medication recommendations, with an acceptance rate of 86%. The involvement of pharmacists in the multidisciplinary care team can effectively provide medication-related recommendations, ensuring the effectiveness and safety of patients' medication use, and lead to better kidney function and lower proteinuria.

Influence of cholesterol levels on NSAID-associated risks after myocardial infarction: a nationwide population-based cohort study

Abstract Introduction Non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat pain, fever, and inflammation, but they can increase the risk of recurrent myocardial infarction (MI), ischemic stroke, atrial fibrillation, and death in patients with MI. Consequently, the European Society of Cardiology warns against using NSAIDs in patients with manifest cardiovascular disease and in high-risk individuals, such as those with dyslipidemia. However, no study has investigated whether NSAID-associated cardiovascular risks differ according to patients’ low-density lipoprotein cholesterol (LDL-C) levels. Purpose To examine whether LDL-C levels influence the cardiovascular risk associated with NSAID use after first-time MI. Methods Using Danish health registries, we conducted a population-based cohort study of all adult patients with a first-time MI hospitalization during 2010–2020 with an LDL-C value before discharge. Based on the latest LDL-C value, we categorized patients into a low and high LDL-C group (&amp;lt;3 vs. ≥3 mmol/L). We used multivariate Cox regression to compute adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for the association between NSAID use (modelled in time-varying manner) and a major adverse cardiovascular event (MACE), defined as a composite of recurrent MI, ischemic stroke, and all-cause death. We repeated the analysis by changing the cut-off value for LDL-C to 1.8 and 1.4 mmol/L. Results We followed 50,573 patient with a first-time MI for a mean of 3.5 years (66% males, median age of 68 years. During NSAID use, 521 patients experienced a MACE: 312 in the low LDL-C group and 209 in the high LDL-C group. The HRs for MACE comparing NSAID use with non-use were 1.21 (1.11–1.32) overall, 1.19 (1.06–1.33) in the low LDL-C group, and 1.23 (1.07–1.41) in the high LDL-group. The HRs in the low and high LDL-C groups were 1.09 (0.88–1.34) vs. 0.94 (0.74–1.19) for recurrent MI, 0.97 (0.66–1.41) vs. 1.27 (0.86–1.87) for ischemic stroke, and 1.22 (1.07–1.39) vs. 1.54 (1.30–1.83) for all-cause death. Changing the cut-off value for LDL-C to 1.8 and 1.4 mmol/L showed consistent results. Conclusion In patients with a first-time MI, NSAID use was associated with an increased risk of MACE. The LDL-C level did not influence the association between NSAID use and MACE, but it might influence the association between NSAID use and all-cause death. Thus, healthcare providers should be mindful of the increased cardiovascular risk associated with NSAID use in patients with previous MI, regardless of LDL-C values.

Predictors of treatment failure of non-steroidal anti-inflammatory drugs in patients with axial spondyloarthritis with focus on haptoglobin, haptoglobin polymorphism and zonulin.

According to the Assessment of SpondyloArthritis International Society-European Alliance of Associations for Rheumatology (ASAS-EULAR) recommendations for the management of axial spondyloarthritis (axSpA), patients should undergo at least two courses of non-steroidal anti-inflammatory drugs (NSAIDs) therapy. In our study, we enrolled axSpA patients both at onset and in a flare who had already been treated with NSAIDs ineffectively. Subsequently, according to the recommendations, they received modified NSAID treatment as another attempt to the first-line drug therapy and were monitored from there. We aimed to identify risk factors for treatment failure after 4weeks (Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score ≥ 4) especially amongst zonulin and haptoglobin concentrations, and haptoglobin polymorphism. Treatment failure was observed in 71% of patients, and the following variables were contributed for occurrence of this state: higher zonulin levels, ankylosing spondylitis, X-ray sacroiliitis, magnetic resonance imaging sacroiliitis, long duration of symptoms, high BASDAI, and high value of spinal pain intensity on visual analogue scale. In addition, the following positive correlations were found: haptoglobin concentration with C-reactive protein (r = 0.56; p = 0.0004), and erythrocyte sedimentation rate (r = 0.62; p < 0.0001), as well as between zonulin levels and white blood count (r = 0.5; p = 0.0003). The results of the study presented the identified factors related to the standard treatment failure in axSpA, amongst them zonulin levels. They might be applied to point out the patients for whom the search for a more appropriate method of treatment should be considered.

Niesteroidowe leki przeciwzapalne u chorych leczonych iniekcjami doszklistkowymi - codzienna praktyka czy doraźne działanie?

Iniekcje leków do ciała szklistego są jednymi z najczęstszych zabiegowych procedur okulistycznych w codziennej praktyce klinicznej. Do ciała szklistego podaje się przede wszystkim leki blokujące czynniki wzrostu śródbłonka naczyń. Iniekcje doszklistkowe wykonuje się w znieczuleniu miejscowym kroplowym, ale nie wszystkim chorym zapewnia ono wystarczającą analgezję. Dlatego okuliści sięgają po inne leki o działaniu przeciwbólowym, takie jak niesteroidowe leki przeciwzapalne. Dodatkowo zapalenie stanowi wspólny element patogenezy szeregu chorób plamki leczonych iniekcjami doszklistkowymi, np. wysiękowe zwyrodnienie plamki związane z wiekiem. W artykule przedstawiono mechanizm działania niesteroidowych leków przeciwzapalnych oraz wskazania okulistyczne do ich zastosowania. Opisano wpływ tej grupy leków na zmniejszenie dolegliwości bólowych, które towarzysząc iniekcjom doszklistkowym. Przedstawiono korzystny wpływ terapii złożonej z miejscowymi niesteroidowymi lekami przeciwzapalnymi na częstotliwość podań leków blokujących czynniki wzrostu śródbłonka naczyń i morfologię siatkówki u chorych na wysiękowe zwyrodnienie plamki związane z wiekiem. Wnioski. Należy rozważyć niesteroidowe leki przeciwzapalne jako terapię uzupełniającą do doszklistkowych iniekcji preparatów o działaniu blokującym czynniki wzrostu. Ponadto działanie przeciwbólowe niesteroidowych leków przeciwzapalnych uzasadnia ich użycie w codziennej praktyce klinicznej w okresie okołoiniekcyjnym, zwłaszcza u osób odczuwających nasilone dolegliwości bólowe w związku z powtarzalnymi zabiegami.

Circulating miR-222-3p is associated with ankylosing spondylitis development and predicts therapeutic efficacy of nonsteroidal anti-inflammatory drugs.

Ankylosing spondylitis (AS) is a chronic rheumatic disease, and some microRNAs (miRNAs) in AS have been identified. This study aimed to measure miR-222-3p expression in AS patients, investigate the association of miR-222-3p with AS disease activity, and explore the clinical value of miR-222-3p in diagnosing AS and predicting therapeutic efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) on AS patients. This study included 96 patients with AS, 58 patients with rheumatoid arthritis (RA), and 90 healthy controls. miR-222-3p expression was detected by reverse-transcription quantitative polymerase chain reaction (PCR). The ability of miR-222-3p to discriminate between different groups was evaluated by receiver operating characteristic analysis. The predictive value of miR-222-3p on the efficacy of NSAID treatment for AS was assessed by logistic regression analysis. AS patients treated with oral NSAIDs diclofenac sodium were divided into response (n = 76) and no-response (n = 20) groups after 16 weeks of treatment. miR-222-3p in AS patients was higher than that in healthy subjects and RA patients. miR-222-3p had high diagnostic value in distinguishing patients with AS from RA patients and healthy controls. miR-222-3p, increased in active AS patients, had the ability to screen active AS patients from inactive AS patients. miR-222-3p was decreased in the response group, and had high accuracy in predicting the therapeutic efficiency of NSAIDs. The findings indicate that increased miR-222-3p in AS patients may function as a diagnostic biomarker for AS, and predictive biomarker for the therapeutic efficacy of NSAIDs in patients with AS. In addition, miR-222-3p is associated with AS disease activity.

Major adverse cardiovascular events and mortality with opioids versus NSAIDs initiation in patients with rheumatoid arthritis

ObjectiveAssess major adverse cardiovascular event (MACE) risk with opioids compared with non-steroidal anti-inflammatory drugs (NSAIDs) in patients with rheumatoid arthritis (RA)MethodsWe conducted a new-user active comparator cohort study among patients...

Comparative effectiveness of generic commercial versus locally customized clinical decision support tools to reduce prescription of nonsteroidal anti-inflammatory drugs for patients with heart failure.

To compare the effectiveness of 2 clinical decision support (CDS) tools to avoid prescription of nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with heart failure (HF): a "commercial" and a locally "customized" alert. We conducted a retrospective cohort study of 2 CDS tools implemented within a large integrated health system. The commercial CDS tool was designed according to third-party drug content and EHR vendor specifications. The customized CDS tool underwent a user-centered design process informed by implementation science principles, with input from a cross disciplinary team. The customized CDS tool replaced the commercial CDS tool. Data were collected from the electronic health record via analytic reports and manual chart review. The primary outcome was effectiveness, defined as whether the clinician changed their behavior and did not prescribe an NSAID. A random sample of 366 alerts (183 per CDS tool) was evaluated that represented 355 unique patients. The commercial CDS tool was effective for 7 of 172 (4%) patients, while the customized CDS tool was effective for 81 of 183 (44%) patients. After adjusting for age, chronic kidney disease, ejection fraction, NYHA class, concurrent prescription of an opioid or acetaminophen, visit type (inpatient or outpatient), and clinician specialty, the customized alerts were at 24.3 times greater odds of effectiveness compared to the commercial alerts (OR: 24.3 CI: 10.20-58.06). Investing additional resources to customize a CDS tool resulted in a CDS tool that was more effective at reducing the total number of NSAID orders placed for patients with HF compared to a commercially available CDS tool.

Guideline on the investigation and management of acute transfusion reactions.

Guideline on the investigation and management of acute transfusion reactions.

Suppression of acute bone marrow edema (osteitis) in the sacroiliac joints with long-term use of non-steroidal anti-inflammatory drugs in patients with axial spondyloarthritis

Long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) is a concern for both doctors and patients. However, in axial spondyloarthritis (axSpA), NSAIDs are used not only as a symptomatic therapy, but also to prevent the progression of the disease. Therefore, in active axSpA, NSAIDs are recommended to be administered for a much longer period of time than it is indicated in the instructions for use of the drug. The article presents two clinical cases of long-term use of etoricoxib in active axSpA. In both cases, clinical efficacy and resolution of active osteitis in the sacroiliac joints, good tolerability of treatment were noted.

Potential predictors for the efficacy of non-steroidal anti-inflammatory drugs in patients with migraine

ObjectivesTo explore potential predictors of the efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) in patients with migraine. MethodsConsecutive migraine patients were recruited and divided into responders and non-responders to NSAIDs according to follow-up for at least three months. Demographic data, migraine-related disabilities and characteristics, and psychiatric comorbidities were evaluated and used to build multivariable logistic regression models. Subsequently, we generated receiver operating characteristic (ROC) curves to explore the performance of these traits in predicting NSAIDs efficacy. ResultsA total of 567 patients with migraine who completed at least three months of follow-up were enrolled. In the multivariate regression analysis, five factors were identified as potential predictors for NSAIDs efficacy in treating migraine. Namely, attack duration (odds ratio (OR) = 0.959; p < 0.001), headache impact (OR = 0.966; p = 0.015), depression (OR = 0.889; p < 0.001), anxiety (OR = 0.748; p < 0.001), and education level (OR = 1.362; p < 0.001) were associated with response to NSAIDs treatment. The area under the curve, sensitivity, and specificity combining these five factors for predicting the efficacy of NSAIDs were 0.834, 0.909 and 0.676. ConclusionsThese findings suggest that migraine-related and psychiatric factors are associated with the response to NSAIDs in migraine management. Identifying such key factors may help to optimize individualized migraine management strategy.

Comparative evaluation of the efficacy and safety of intra-articular administration of hyaluronic acid and glucocorticoids in the complex therapy of osteoarthritis

Improving the treatment of knee (KN) osteoarthritis (OA) remains an urgent problem.Objective: to compare the efficacy and tolerability of intra-articular (i/a) administration of long-acting glucocorticoids (GCs) and Armaviscon®Forte and Armaviscon®Platinum hyaluronates in patients with knee OA.Material and methods. From November 2019 to April 2022, we examined and treated 60 patients (26 men and 34 women, mean age 41.32±3.71 years) suffering from primary KN OA. Study participants were randomly divided into three groups of 20 patients each. In the 1st group, a longacting GCs in combination with a local anesthetic was administered once i/a into the KN, in the 2nd – Armaviscon®Forte 2.3%, and in the 3rd – Armaviscon®Platinum 3%.Patients were examined at baseline, on the 14th and 60th day after a single injection of the drug. The intensity of pain was assessed on a visual analog scale (VAS), the Lequesne index, the KOOS, WOMAC, and EQ-5D questionnaires were used. When studying tolerability, the number of adverse reactions (ARs) was taken into account.Results. By the end of the observation period in the study groups, there was a decrease in the severity of pain and an increase in functionality with positive dynamics of the Lequesne and WOMAC indices. Both hyaluronic acid drugs had a positive effect on the functional state of the joints according to KOOS, improved the quality of life according to EQ-5D. The need for non-steroidal anti-inflammatory drugs in patients of the 2nd and 3rd groups decreased down to their complete cancellation. No adverse events requiring discontinuation of therapy have been reported. The advantage of i/a administration of hyaluronates in comparison with long-acting GCs was shown.Conclusion. In real clinical practice, in patients with symptomatic OA, i/a administration of hyaluronates allows obtaining more favorable results than the use of long-acting HA.

Efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs) for the treatment of acute pain after orthopedic trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma and the Orthopedic Trauma Association

ObjectivesFracture is a common injury after a traumatic event. The efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs) to treat acute pain related to fractures is not well established.MethodsClinically relevant...

Non-steroidal anti-inflammatory drugs for pain in hospice/palliative care: an international pharmacovigilance study

ObjectivesTo describe the current, real-world use of non-steroidal anti-inflammatory drugs for pain and the associated benefits and harms.MethodsA prospective, multicentre, consecutive cohort pharmacovigilance study conducted at 14 sites across Australia,...

7-yi Makmasterskyi mizhnarodnyi ohliadovyi kurs z vnutrishnoi medytsyny (7th McMaster International Review Course in Internal Medicine - MIRCIM) - 29.09-01.10.2022 (Krakiv, Respublika Polshcha)

On September 28 – October 1, 2022, the 7th MIRCIM 2022 international conference was held in Krakow (Poland). The conference, which brought together internal medicine doctors, family doctors, narrow specialists of a therapeutic profile, had eight sections corresponding to eight main sections of internal medicine – cardiology, endocrinology, pulmonology, nephrology, rheumatology, gastroenterology, hematology, chronic infections. Professors with international recognition from the USA, Canada, Germany, France, Great Britain, Israel, India, and Mexico had the lectures. In the endocrinological section, the determination of the content of thyroid hormone, the diabetes mellitus treatment new possibilities, the experience of diagnosis and treatment of glucocorticosteroid-induced adrenal insufficiency were discussed. In the section of cardiovascular diseases, the speakers proposed to discuss the issue of acute heart failure, differences in the occurrence and course of cardiovascular diseases in women and men. In the pulmonology session, the lectures on the modern treatment of asthma, the use of nonsteroidal anti-inflammatory drugs in patients with respiratory diseases exacerbations, and the issue of the chronic obstructive pulmonary disease severity course reducing were presented. The nephrology section was presented by the reports on the topics: “Infections and kidneys”, “Optimal nephroprotection in patients with chronic kidney disease”. Professor Tracy Balboni emphasized the importance of spiritual care in the treatment of the critically ill patients and the role of spirituality in medicine and health care in general. The gastroenterology block of reports was devoted to the tactics of management and treatment of helicobacter pylori infection, intestinal polyps and non-alcoholic fatty liver disease. As part of the hematology unit, Professor Andreas Greinacher spoke about heparin-induced, vaccine-induced and other immune thrombocytopenias. At the rheumatology section.

Population-Based Analysis of Nonsteroidal Anti-inflammatory Drug Prescription in Subjects With Chronic Kidney Disease

Pain is a prevalent symptom experienced by patients with chronic kidney disease (CKD) and appropriate management of pain is an important element of comprehensive care. Nonsteroidal anti-inflammatory drugs (NSAID) are known to be nephrotoxic in persons with CKD. This study examined the pattern of NSAID prescribing practices in a population based-cohort of patients with CKD. Retrospective cohort study using linked population-based health care data. Entire province of Alberta, Canada. All adults in Alberta with eGFR defined CKD G3 or greater between 2009 and 2017 were included. CKD was defined using at least 2 outpatient serum creatinine (SCr) greater than 90 days apart; the date of second SCr measurement was used as index date. We determined the incidence of hyperkalemia using the peak serum potassium. Prescription drug information was obtained from the Pharmaceutical Information Network (PIN) database. All patients were followed from the index date until March 31, 2019, with a minimum follow-up of 2 years. Prescription drug information and the follow-up laboratory testing of serum creatinine and serum potassium were obtained. Patients with kidney failure defined as eGFR < 15 mL/min per 1.73 m2, receiving chronic dialysis, or prior kidney transplant at baseline were excluded. A total of 170 574 adults (mean age 76.3; 44% male) with CKD were identified and followed for a median of 7 years; 27% were dispensed at least 1 NSAID prescription. While there was a trend toward fewer prescriptions in patients with more advanced CKD (P < .001), 16% of those with CKD G4 were prescribed an NSAID. Primary care providers provided 79% of the prescriptions. Among NSAID users, 21% had a follow-up serum creatinine (SCr) within 30 days of the index prescription. Data collected were from clinical and administrative databases not created for research purposes. The study cohort is limited to subjects who sought medical care and had a serum creatinine measurement obtained. Measurement of NSAID use is limited to those who were dispensed a prescription, over-the-counter NSAIDs use is not captured. Despite guidelines advocating cautious use of NSAIDs in patients with CKD, this study indicates that there is a discrepancy from best practice recommendations. Effective strategies to better support and educate prescribers, as well as patients, may help reduce inappropriate prescribing and adverse events.

Approach to dysmenorrhoea in primary care.

Approach to dysmenorrhoea in primary care.