Topical Nonsteroidal Anti-inflammatory Drugs Research Articles

Topikalni nesteroidni antiinflamatorni lekovi - koliko su značajni u lečenju mišićnoskeletnog bola

Topical nonsteroidal anti-inflammatory drugs are an effective and safe therapeutic option for the treatment of acute and chronic musculoskeletal disorders. Based on evidence from the literature, topical NSAID's have a clearly defined place in the treatment of acute musculoskeletal pain and in the treatment of osteoarthritis of the hands and knees. Due to the rare systemic side effects, they should always be advised as the first therapeutic line for the treatment of musculoskeletal pain in osteoarthritis of the hands and knees of patients ≥75 years of age. It is very important that there are no recommendations for the use of other topical preparations, such as rubefaciens and capsaicin for the treatment of painful musculoskeletal conditions. Clinical assessment of the patient, the condition of medical issue and the choice of the optimal NSAID's formulation, contribute to the success of the treatment. Gel formulations represent the optimal substrate for topical NSAID's both for best penetration and for best acceptance by patients. Gel formulations of topical NSAID's represent the optimal substrate for transdermal penetration and are best accepted by patients. They are also the optimal medium for sonophoresis, which is why they can be widely used in the field of physical medicine and rehabilitation.

Ocular involvement in rheumatoid arthritis – literature review

Rheumatoid arthritis (RA) is the most common systemic autoimmune disease that can be associated with ocular complications – keratoconjunctivitis sicca, episcleritis, scle­ri­tis, corneal changes and retinal vasculitis. The purpose of the review is to illustrate the ocular mani­fes­ta­tions of RA, focusing on pathogenesis, clinical examination and the­ra­peutic management. Eye manifestations in RA benefit from the use of artificial tears, eye gels, ointments or topical nonsteroidal anti-inflammatory drugs or corticosteroids. Nonresponsive or severe forms should benefit from topical drops containing the supply of immunosuppressants or cy­clo­sporine A. Rheumatic disease-modifying medication (DMARDs) has been reported to be effective in patients with refractory or corticosteroid-dependent cases. Bio­lo­gi­cal substances – infliximab, adalimumab and ri­tu­xi­mab – can be used successfully in patients considered nonresponders to synthetic therapy. Surgical treatment is re­served for severe cases, which are associated with local com­pli­ca­tions. In conclusion, collaborative efforts between oph­thal­mo­lo­gists and rheumatologists in the assessment and treatment of patients with RA are essential for the effective management of any ocular complications that may occur. rheumatoid arthritis, ocular manifestations, specific therapy

Comparison of pupillary diameter variation between conventional phacoemulsification versus femtosecond laser-assisted cataract surgery

Purpose: To evaluate and compare variations in pupillary diameter before and after cataract surgery by conventional phacoemulsification versus femtosecond laser assisted cataract surgery, using LDV Z8 (Ziemer Ophthalmic). We also evaluated the relationship between pupillary diameter and surgery time and ultrasound time. Methods: Prospective comparative study, carried out at the Center of Excellence in Ophthalmology, Brazil. We included 79 eyes of 67 patients with nuclear opacity. The patients were divided into the control and study groups, including those who underwent cataract surgery with manual phacoemulsification, and femtosecond laser assisted cataract surgery, respectively. All surgeries were performed by the same experienced surgeon. All patients received topical non-steroidal anti-inflammatory drugs on the day before surgery and the same mydriatic eye drops preoperatively. To quantify pupillary size, measurements were performed using a surgical compass: anterior to the phacoemulsification procedure and at the end of the surgery. In the study group, measurements after laser were added. Surgical time and phacoemulsification time were also analyzed. Results: No significant difference was found between the pre-femto × pre-phaco pupil size (8.69 ± 0.44 mm × 8.63 ± 0.72 mm; p=0.643), and the pupil size at the end of surgery (7.96 ± 0.98 mm × 7.78 ± 0.95 mm; p=0.480) and the mean time of surgery (p=0.780). However, in the femtosecond laser assisted cataract surgery group, a transient increase in pupillary diameter after laser treatment was observed, indicating a tendency for greater variation in the femto group. Conclusions: Although pupil size diameter was similar at the end of surgery, the femtosecond laser assisted cataract surgery group presented higher intraoperative pupil variation. The surgeon should be aware of pupil size diameter before surgery for better and safer performance of femtosecond laser assisted cataract surgery.

Non-Steroidal Anti-Inflammatory Drugs and Risk of Acute Kidney Injury and Hyperkalemia in Older Adults: A Retrospective Cohort Study and External Validation of a Clinical Risk Model.

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used analgesics among older adults. Adverse effects may be avoided by careful patient selection. We aimed to evaluate the incidence of acute kidney injury (AKI) and/or hyperkalemia, risk factors, and the accuracy of an NSAID risk prediction model in a cohort of Asian older adults. We conducted a retrospective cohort study of older adults, age 65years and above, who received prescriptions between March 2015 and December 2017 from Singapore's largest cluster of public healthcare institutions. Factors associated with 30-day incident acute kidney injury and/or hyperkalemia were evaluated with multivariable regression analysis. Calibration and discrimination of the Nash prediction model were assessed using the Hosmer-Lemeshow goodness-of-fit test and C-statistic, respectively. The primary outcome occurred in 16.7% of 12,798 older adults. Topical NSAIDs (adjusted OR 1.29, 95% CI 1.15-1.45), systemic NSAIDs of 1-14 days' duration (adjusted OR 1.43, 95% CI 1.27-1.62), and systemic NSAIDs > 14 days (adjusted OR 1.84, 95% CI 1.37-2.49) were independently associated with the primary outcome, compared with no NSAID. Diabetes mellitus, cardiovascular disease, lower estimated glomerular filtration rate (eGFR), and diuretics were also independently associated with increased incident AKI and/or hyperkalemia. When applied to older adults with systemic NSAIDs > 14 days (n=305), the Nash risk model had poor calibration (p<0.001) and poor discrimination with C-statistic 0.527 (0.438, 0.616). Longer NSAID duration and systemic compared with topical route were associated with incremental odds for acute renal events. Further studies are required to improve the available risk model to guide NSAID prescriptions in older adults.

Topical nonsteroidal anti-inflammatory drugs for management of pain syndrome

Chronic pain continues to remain one of the urgent problems of modern medicine. From 15 to 25% of the adult population suffers from chronic pain. Medical treatment includes the appointment of non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants. The greatestform for the appointment of NSAIDs is the topical form. According to the recommendations of International and National societies for the treatment of pain syndrome, osteoarthritis (OA) therapy are recommended to start with topical NSAIDs, as drugs with less systemic adverse side effects (NSAIDs).Topical NSAIDs have proven analgesic and antiinflammatory efficacy in the treatment of diseases of the musculoskeletal system, musculoskeletal pain, but have a low risk of developing systemic NSAIDs in comparison with oral forms, which expands the possibilities of their appointment in patients with comorbid pathology (diseases of the gastrointestinal tract, cardiovascular risks).Among NSAIDs, diclofenac is the "gold standard" of analgesia. After topical application, diclofenac penetrates through the skin and further into the deeper underlying tissues while maintaining sufficient concentration to provide a therapeutic effect. The topical form of diclofenac – diclofenac diethylamine 2%, when used correctly, can cause an analgesic effect comparable to the oral form. This topical form has a high clinical efficacy in the treatment of acute musculoskeletal pain (sprains), the course of therapy takes 1 week, for chronic pain syndromes (knee OA or hand) the course of therapy is from 2 to less than 6 weeks. The clinical efficacy of diclofenac diethylamine monotherapy is comparable to that for complex therapy in combination with oral forms of NSAIDs, while having good tolerability.

A Retrospective Study on the Efficacy of Two Different Rehabilitation Interventions on KOA: Shock Wave Therapy vs. Electroacupuncture Therapy.

Objective In this paper, we retrospectively reviewed the difference in clinical effectiveness of shock wave therapy and electroacupuncture therapy on knee osteoarthritis. Methods A total of 128 treatment cases of knee osteoarthritis patients were extracted from the medical record system of Shenzhen Longhua District Central Hospital during the period from January 1, 2018, to January 30, 2020. The cases were divided into three groups for different treatments: shock wave group (n = 54), electroacupuncture group (n = 41), and control group (n = 33). The shock wave group was given shock wave therapy combined basis clinical treatment; meanwhile, the electroacupuncture group was given electroacupuncture on the basis of actual clinical treatment. The control group was given conventional topical nonsteroidal anti-inflammatory drugs (Voltaren). Osteoarthritis index scale, NRS scale, and WHOQOL-BREF were observed before treatment, after 2 weeks, and 4 weeks after treatment. Results This study found that the osteoarthritis index scale and NRS scale of the shock wave group and the electroacupuncture group were lower than those before treatment; it had significant difference (P < 0.001). In WHOQOL-BREF, the shock wave group and the electroacupuncture group improved significantly four weeks after treatment (P < 0.001), which was statistically different from the conventional group (P = 0.04). Conclusion Physical and rehabilitation medicine treatment (shock wave therapy) and traditional medical treatment (electroacupuncture) have better clinical effects on knee osteoarthritis, compared with conventional treatment. Shock wave and electric acupuncture have no apparent adverse reaction, suggesting that the treatment is safe and effective.

Effect of topical non-steroidal anti-inflammatory drugs on healing times and complications in dogs with spontaneous chronic corneal epithelial defects.

Little is published regarding topical NSAID effect on corneal healing in dogs. This retrospective cohort study aimed to compare healing times and complications in dogs with spontaneous chronic corneal epithelial defects (SCCED) treated with and without topical non-steroidal anti-inflammatory drugs (NSAID). Medical records of 66 dogs (71 eyes) diagnosed with SCCED between 2008 and 2019 were included. Eyes were divided into: (1) those receiving topical NSAIDs (n=33) versus (2) those not receiving topical NSAID (n=38). Follow-up until healed, such as comfortable eye, negative fluorescein stain was required. Use of topical or systemic anti-inflammatories outside of NSAID or presence of ocular disorders or systemic endocrinopathies that may contribute to delayed healing resulted in study exclusion. Healing times were significantly longer in eyes that received topical NSAID (p=0.008), however, the use of more topical medications for treatment was also associated with longer healing times (p=0.001). The majority of eyes in the NSAID group received multiple medications, compared to the non-NSAID group, so it was not possible to separate the effects of NSAID from a number of medications. Complications occurred in three eyes of three dogs within the NSAID group. In these canine SCCED eyes, the use of more topical medications, including NSAID, was associated with significantly delayed healing time.

Effectiveness and safety of acupotomy for knee osteoarthritis: study protocol for a randomized controlled trial

BackgroundKnee osteoarthritis (KOA) is one of the most common musculoskeletal disorders. Acupotomy may be effective for KOA, but the evidence is limited. This trial aims to determine the effectiveness and safety of acupotomy for KOA.Methods/designThis is a parallel-group, assessor-blinded randomized controlled trial. Two hundred patients with KOA will be recruited and randomly assigned to two groups (group A or group D) in a 1:1 ratio. Patients in group A will receive acupotomy and topical diclofenac diethylamine for 4 weeks, while patients in group D will receive topical diclofenac diethylamine alone for 4 weeks. The primary outcome will be the response rate—the proportion of patients who achieve the minimal clinically important improvement in pain and function at week 4 compared with baseline. Secondary outcomes will include pain, function, quality of life, the use of rescue medicine (loxoprofen sodium), and adverse events at weeks 4, 8, and 24 after randomization. Besides, joint fluid and serum will be collected to assess the level of inflammatory cytokines, like TNF-α, IL-1β, and MMP-3.DiscussionThis study will contribute to a better understanding of the effectiveness and safety of acupotomy in combination with topical nonsteroidal anti-inflammatory drugs. If the hypothesis is confirmed, acupotomy may be recommended as adjunctive therapy for patients with KOA. Results of the study will be of great importance for the guidelines of clinical therapy.Trial registrationChinese Clinical Trial Registry ChiCTR2100043005 Registered on 4 February 2021.

The possibilities of using topical nonsteroidal anti-inflammatory drugs in the complex pain syndrome therapy of musculoskeletal system diseases

Diseases of the peripheral joints (osteoarthritis OA) and the spine are the most common pathology among other chronic conditions. One of the most common diseases characterized by degenerative periarticular changes with various clinical manifestations is periarthritis. Unlike OA, periarthritis is characterized by a discrepancy between active and passive movements, increased pain during strictly defined movements, the absence of joint swelling or local swelling in the projection of the affected tendon. As the basic therapy of OA (step 1), it is recommended to prescribe locally nonsteroidal anti-inflammatory drugs (NSAIDs), as drugs with less systemic adverse effects. Local NSAIDs have a sufficient analgesic effect in knee joints OA. Among topical NSAIDs for reducing pain in knee joints OA and periarticular tissues, diclofenac gel (Voltaren Emulgel 2%) is approved for use, the effectiveness of which has been demonstrated in many studies. To achieve maximum effect, the gel is applied according to the instructions for use of the drug: 2 ml on the anterior, posterior and lateral surfaces of the knee 2 times a day (every 12 hours) for 4 weeks.

Topical NSAIDs, intravitreal dexamethasone and peribulbar triamcinolone for pseudophakic macular edema

BackgroundThe purpose of this study is to assess the effectiveness of topical nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids (intravitreal dexamethasone and peribulbar triamcinolone) in treating pseudophakic macular edema (PME).MethodsRetrospective study of 33 eyes. Variables included best corrected visual acuity (BCVA; logMAR scale) and central retinal thickness (CRT) and central choroidal thickness (CCT) assessed with swept-source OCT. All patients were initially prescribed topical NSAIDs and reevaluated after 2 months. If improvement in BCVA or CRT was noted, topical NSAIDs were continued until resolution. If no improvement was observed at 2 months or subsequent visits, intravitreal dexamethasone implant was performed. Patients who refused intravitreal treatment were offered peribulbar triamcinolone.ResultsAfter treatment with topical NSAIDs for a median of 2 months, BCVA increased significantly from 0.5 to 0.3 while CRT decreased significantly from 435 to 316 μm. PME resolved in 19 of the 33 eyes (57.6%). Of the 14 recalcitrant cases, 13 were treated with corticosteroids. Of these 13 cases, 9 (69.2%) resolved. BCVA increased non-significantly from 0.7 to 0.4. CRT and CCT decreased significantly from 492 to 317 μm and from 204 to 182 μm respectively.ConclusionsThe overall success rate of the treatment algorithm was greater than 80%, a remarkable finding considering that no randomized study has yet been conducted to determine the optimal therapeutic protocol for PME. This is the first study to evaluate choroidal thickness in PME using SS-OCT, which could play a key role in its pathophysiology and provide useful information to improve the management of PME.

Effectiveness and safety of non-steroidal anti-inflammatory drugs and opioid treatment for knee and hip osteoarthritis: network meta-analysis

ObjectiveTo assess the effectiveness and safety of different preparations and doses of non-steroidal anti-inflammatory drugs (NSAIDs), opioids, and paracetamol for knee and hip osteoarthritis pain and physical function to enable...

Hoornvliesbeschadiging na cataractchirurgie: belang van het droge-ogensyndroom en topische NSAID’s en oppuntstelling van de behandeling

Dry eye disease and cataract surgery: identification of risk factors for corneal damage and optimisation of treatment Various factors in the perioperative cataract surgery period can synergistically initiate a vicious inflammatory cycle of dry eye disease (DED) and tissue damage, with dire consequences. A careful anamnesis and preoperative assessment of the ocular surface can reveal some of the risk factors and facilitate an appropriate perioperative approach. Attention should be paid to DED and associated conditions, such as Meibomian gland dysfunction, as these conditions are very common. In the postoperative period, it is wise to avoid preserved topical medication, as well as to use topical medication that may be toxic to the ocular surface, such as non-steroidal anti-inflammatory drugs (NSAIDs), with care in specific cases. The treatment of DED and its complications consists primarily of the careful use of lubricating, antibiotic and anti-inflammatory agents. In serious DED cases, autologous serum promotes tissue regeneration by promoting epithelialisation and stromal recovery, and can be a useful adjunct to the first-line treatment. In extreme and rare cases, DED can, in combination with the use of topical NSAIDs and other risk factors, lead to sight-threatening complications, such as corneal melting. A surgical treatment consisting of conjunctival flap transplantation, amniotic membrane transplantation, gluing of the cornea or tectonic keratoplasty may be necessary when perforation is imminent.

CYSTOID MACULAR EDEMA AFTER FOUR-POINT SCLERAL FIXATION OF INTRAOCULAR LENS.

To assess the incidence of cystoid macular edema (CME) associated with 4-point Gore-Tex suture intraocular lens (IOL) scleral fixation, before and after institution of routine intravitreal triamcinolone acetonide prophylaxis and long-term topical nonsteroidal anti-inflammatory drug usage. Consecutive patients were included after IOL implantation with concurrent pars plana vitrectomy for spontaneous IOL dislocation due to pseudoexfoliation syndrome. We compared short-term prophylactic nonsteroidal anti-inflammatory drugs only (Group A) to prophylactic intravitreal triamcinolone acetonide and long-term nonsteroidal anti-inflammatory drugs (Group B). Twenty-six eyes of 26 patients with pseudoexfoliation syndrome and spontaneous IOL dislocation were studied. Mean logMAR visual acuity improved from 1.27 ± 0.80 (20/375 Snellen equivalent) preoperatively to 0.46 ± 0.39 (Snellen 20/43) postoperatively (P < 0.001). Visual outcomes were similar for Groups A and B. In Group A, 10/16 eyes had CME, 4/16 had chronic CME longer than 6 months, and 1 longer than 12 months. In Group B, 1/10 had CME (which was both chronic and refractory). In eyes with pseudoexfoliation syndrome and spontaneous IOL dislocation, 4-point Gore-Tex suture IOL ab externo fixation yielded good visual outcomes, although CME was observed more than reported elsewhere. Prophylactic intravitreal triamcinolone acetonide and long-term nonsteroidal anti-inflammatory drugs seem to reduce the risk of postoperative CME.

Current Management Options in Irvine-Gass Syndrome: A Systemized Review.

Irvine–Gass syndrome (IGS) remains one of the most common complications following uneventful cataract surgery. In most cases, macular edema (ME) in IGS is benign, self-limiting, and resolves spontaneously without visual impairment; however, persistent edema and refractory cases may occur and potentially deteriorate visual function. Despite the relatively high prevalence of IGS, no solid management guidelines exist. We searched the PUBMED database for randomized clinical trials (RCT) or case series of at least 10 cases published since 2000 evaluating different treatment strategies in patients with cystoid macular edema (CME). The search revealed 28 papers that fulfilled the inclusion criteria with only seven RCTs. The scarceness of material makes it impossible to formulate strong recommendations for the treatment of IGS. Clinical practice and theoretical background support topical non-steroidal anti-inflammatory drugs (NSAIDs) as the first-line therapy. Invasive procedures, such as periocular steroids, intravitreal corticosteroids, and anti-vascular endothelial growth factor (anti-VEGF), are usually applied in prolonged or refractory cases. Results of novel applications of subthreshold micropulse laser (SML) are also promising and should be studied carefully in terms of the safety profile and cost effectiveness. Early initiation of invasive treatment for providing better functional results must be examined in further research.

Evaluating the Safety of Non-Steroidal Anti-inflammatory Drugs use in Asthmatic Patients: A Systematic, Critical Review of Literature

Background: Evidence suggest avoidance of Non-steroidal anti-inflammatory drugs (NSAID) in aspirinintolerantasthmatics due to the risk of triggering exacerbation attack; however, evidence around avoidingNSAIDs in all other asthmatic patients are unclear. This study aimed to evaluate the evidence surroundingthe safety of using NSAIDs, including selective COX-2 inhibitors, among asthmatic patients.Methods: A systematic review used Medline (OVID), Scopus and Embasefrom January-2008 toJanuary-2019. Inclusion criteria includedEnglish, and human studies that evaluated the use of NSAID inasthmatics. Data was screened/extracted using a pre-designed data extraction form using Covidence®,thenwere critically appraised.Conclusion: Of the 49 identified studies,eight were eligible. Prevalence of NSAID-induced asthmaexacerbation was 9%(95%CI:6.0–12.0%)-9.9% (95%CI:9.4-10.5%). Asthmatics who were aspirin/NSAIDintolerant had 37% higher risk of hospitalisation compared to tolerant patients (RR:1.37; 95%CI:1.12–1.67).Use of COX-2 inhibitors showed non-significant associations with worsening respiratory symptoms/exacerbation. Only low-quality evidence was found for the safety of topical NSAID. NSAIDs-inducedrespiratory reactions/symptoms is relatively uncommon with the majority of asthmatic patients couldtolerate NSAIDs therapy. Asthmatic patients who suffer from aspirin-induced asthma or NSAIDsexacerbatedrespiratory disease (NSAIDs intolerant) should be avoided NSAIDs prescribing but could besafely prescribed selective COX-2 inhibitors as an alternative.

Multidisciplinary Management of Recurrent Aphthous Stomatitis Triggered by Severe Depression

Background: Recurrent Aphthous Stomatitis (RAS) is an inflammation of the oral mucosa in the form of a single or more ulcer that occurs repeatedly. One of the predisposing factors that contribute to the onset of RAS is depression. Depression is a mood that is not happy or sadness that is experienced as part of the pattern of life. Objective: Discuss multidisciplinary management in cases of 65-year-old women with large multiple ulcers with depression-triggering factors. Case: Women aged 65 years complained of recurrent canker sores. The frequency of RAS increased by 10 years due to economic and household problems. It has been treated with topical non-steroidal anti-inflammatory drugs but does not heal. Does not have a history of systemic diseases. Case Management: Do investigations are complete peripheral blood examination, Depression Anxiety Stress Scale (DASS), Refer patients to the psychiatric specialist. Multidisciplinary treatment is performed by a psychiatric specialist. Treatment of oral mucosa with topical anti-inflammatory steroid drugs. Conclusions: in accordance with the treatment that has been given, this case has recovered after day 14. So it can be concluded that proper multidisciplinary management and elimination of triggering factors are the main roles to prevent recurrence and reduce the frequency of recurrent aphthous stomatitis.

Corrigendum: Effect of a Topical Nonsteroidal Anti-Inflammatory Drug (0.1% Pranoprofen) on VEGF and COX-2 Expression in Primary Pterygium.

Corrigendum: Effect of a Topical Nonsteroidal Anti-Inflammatory Drug (0.1% Pranoprofen) on VEGF and COX-2 Expression in Primary Pterygium.

Contribution of phototesting in the diagnosis of photodermatoses: Retrospective study of 100 cases.

Photodermatoses are sun-related inflammatory skin diseases. They usually require phototesting in diagnosis. However, fewer and fewer medical centers in France are equipped with photobiological equipment. The main purpose was to evaluate the relevance of phototesting in photodermatosis diagnosis. The second goal was to study the proportions of the different kinds of photodermatosis found in this particular study. This study was descriptive, retrospective, and mono-centric. It was based on 100 consecutive patients, who have been phototested in a French University Hospital from 2014 to 2018. Phototesting included determination of the minimal erythematous dose (MED), UVA and UVB phototests, and photopatch testing. The use of phototesting led to 60% of photodermatosis diagnosis and formally eliminated the latter in 13% of the cases. The diagnosis remained undetermined in 27% of the cases. Nineteen cases of polymorphous light eruption (PLE), 14 cases of photocontact dermatitis (PCD), 10 cases of solar urticaria, 8 cases of photo-aggravated atopic eczema, 5 cases of chronic actinic dermatitis, and 2 cases of systemic photosensitization were diagnosed. The allergens involved in PCD were topical non-steroidal anti-inflammatory drug (NSAID) in 9 cases, sunscreens in 3 cases, and fragrance in 2 cases. The average amount of time between the first symptoms and actual phototesting was about 7,5years. This study confirms phototesting is truly useful. PLE was the most common form of photodermatosis, followed by PCD and solar urticaria. As photodermatosis could imply severe diseases sometimes requiring hospitalization, it is critical to maintain this expertise.

Efficacy and Safety of an Etofenamate Medicated Plaster for Acute Ankle Sprain: A Randomized Controlled Trial.

Background:The favorable benefit-risk profile of topical nonsteroidal anti-inflammatory drugs (NSAIDs) makes them a preferred treatment for pain relief in soft tissue injuries.Purpose:To assess the efficacy and safety of a novel etofenamate 70-mg medicated plaster in patients with acute uncomplicated ankle sprain.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:Patients with grade 1 or 2 ankle sprain of recent onset were randomized to etofenamate or placebo plasters (1:1) applied twice daily for 7 days. Clinical assessments, including ankle pain on movement (POM) in mm on a 100-mm visual analog scale (VAS), were made at predefined intervals during the treatment period.Results:In total, 156 male or female adult patients (mean age, 35.3 ± 11.8 years) were enrolled. The fall in VAS values for POM from baseline to 72 hours was markedly in favor of the etofenamate plaster, with respective reductions of 52.7% and 24.0% for active and placebo plasters (least squares mean treatment difference, 22.1 mm; P value for analysis of covariance < .0001). Similar clinically relevant differences between etofenamate and placebo were seen for POM at the 48-, 96-, and 168-hour visits (P < .0001). These differences between etofenamate and placebo plasters were reflected in area under the curve for POM, pain at rest, and ankle swelling measured at various time points during the 7 days. Time taken to achieve a meaningful (30%) and optimal (50%) reduction of POM was significantly shorter in the etofenamate group. The responder rate (proportion of patients with at least 50% pain reduction at 72 hours) was 52.5% for the etofenamate plaster and 7.7% for the placebo. A significantly greater proportion of patients randomized to etofenamate rated their progress and/or the treatment as “good” or “very good.” The medicated plasters adhered well over the 12-hour dosing period and were very well-tolerated.Conclusion:With respect to the investigated indication, uncomplicated ankle sprain, the etofenamate plaster has therapeutic efficacy that is similar to that for the best available topical NSAID formulations.Registration:2016-000252-99 (EudraCT number).

Effect of a Topical Nonsteroidal Anti-Inflammatory Drug (0.1% Pranoprofen) on VEGF and COX-2 Expression in Primary Pterygium.

Purpose: To evaluate the effect of a topical nonsteroidal anti-inflammatory drug (0.1% pranoprofen) on the expression of VEGF and Cox-2 in primary pterygium.Methods: This was a prospective, randomized study. Between January 2019 and April 2020, 120 patients diagnosed with primary pterygium were enrolled and randomly divided into three groups before operation: 1) 40 patients in group 1 received topical pranoprofen 0.1% four times daily for 4 weeks, 2) 40 patients in group 2 received topical fluorometholone 0.1% four times daily for 4 weeks, and 3) patients in group 3 did not receive treatment. For each group, the age, sex, eye type, best-corrected visual acuity (BCVA), intraocular pressure (IOP), duration of onset, combined systemic diseases, and the results regarding vascular endothelial growth factor (VEGF) and cyclo-oxygen-ase-2 (COX-2) in postoperative pterygial tissues were evaluated in detail.Results: There were no significant differences regarding age, sex, eye type, combined systemic diseases, duration of onset, IOP, and BCVA within the three groups (p > 0.05). The reduction of VEGF and CoX-2 expression of pterygial vascular endothelial cells in group 1 were statistically significant compared to group 2 and group 3 (p < 0.05). There were significant correlations between COX-2 and VEGF expression of pterygial tissues within the three groups (p < 0.05).Conclusion: The present findings suggested that the topical pranoprofen 0.1% could reduce the expression of VEGF and COX-2 in primary pterygium. We confirmed that treatment with pranoprofen offers advantages in early intervention and has therapeutic potential in reducing the postoperative recurrence of primary pterygium patients.Clinical Trial registration: The study was registered with the Chinese Clinical Trial Registry. (http://www.chictr.org.cn/index.aspx, Registration Number: ChiCTR2100047726).