Use Of Non-steroidal Anti-inflammatory Drugs In Patients Research Articles

Cardiovascular Implications of Non-steroidal Anti-inflammatory Drugs: A Comprehensive Review, with Emphasis on Patients with Rheumatoid Arthritis.

This review examines the cardiovascular risks associated with the use of non-steroidal anti-inflammatory drugs (NSAIDs), both traditional NSAIDs and cyclooxygenase-2 selective inhibitors (COXIBs). It describes the history of traditional NSAIDs and the development of COXIBs to explain why their cardiovascular side effects were unnoticed for many decades. Further, the review presents the mechanism of action of NSAIDs, to elucidate the possible underlying basis for why they are associated with an increased risk of cardiovascular disease. Finally, data on the cardiovascular risk with NSAID use in patients with rheumatoid arthritis are presented, and we propose possible explanations for why the risk of cardiovascular side effects in these patients seems to be less pronounced than in the general population.

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.

Cardiovascular safety of using non-steroidal anti-inflammatory drugs for gout: a Danish nationwide case-crossover study.

Gout attacks are treated with uric-lowering and anti-inflammatory drugs. In patients with gout, non-steroidal anti-inflammatory drugs (NSAIDs) could be both cardiovascular beneficial, due to their anti-inflammatory actions, and cardiovascular hazardous, due to their prothrombotic, hypertensive, and proarrhythmic side effects. We, therefore, examined the risk of cardiovascular events associated with NSAID use in patients with gout. We conducted a nationwide, population-based case-crossover study of all Danes ≥ 18years of age with first-time gout during 1997-2020, who experienced a cardiovascular event (myocardial infarction, ischemic stroke, congestive heart failure, atrial fibrillation/flutter, or cardiovascular death) (n = 59,150). The exposure was use of NSAIDs, overall and according to type (ibuprofen, naproxen, or diclofenac). We used the dates 300, 240, 180, and 120 before the outcome date as reference dates. We used the Mantel-Haenszel method to calculate odds ratios (ORs) with 95% confidence intervals (CIs) of the association between NSAID use and cardiovascular events. NSAID use was overall associated with 12% decreased odds of a cardiovascular event (OR = 0.88, 95% CI: 0.85-0.91). This decreased odds ratio was observed for the use of ibuprofen (OR = 0.92, 95% CI: 0.88-0.97) and naproxen (OR = 0.85, 95% CI: 0.74-0.97), but not for the use of diclofenac (OR = 0.97, 95% CI: 0.90-1.05).Overall, use of NSAIDs was associated with decreased odds of all the individual components of the composite outcome. NSAIDs were not associated with an increased cardiovascular event rate when used in gout patients.Ibuprofen and naproxen appeared to have better cardiovascular risk profiles than diclofenac.

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 (<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.

Guideline on the investigation and management of acute transfusion reactions.

Guideline on the investigation and management of acute transfusion reactions.

Approach to dysmenorrhoea in primary care.

Approach to dysmenorrhoea in primary care.

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...

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.

Risk of heart failure following short-term non-steroidal anti-inflammatory drug use in patients with type 2 diabetes mellitus

Abstract Background Fluid retention is a known but underappreciated side-effect of non-steroidal anti-inflammatory drug (NSAID) use. As type 2 diabetes mellitus (T2DM) has been linked to both subclinical cardiomyopathy and a decline in kidney function, short-term NSAID use could lead to subsequently development of heart failure (HF) due to aberrations in fluid balances. Purpose We investigated associations between short-term NSAID use and the risk of HF in a nationwide cohort of patients with T2DM. Methods Using nationwide Danish registers, we identified patients diagnosed with T2DM during 1998–2018. Follow-up began 120 days after first-time T2DM diagnosis among patients without prior heart failure or a rheumatological diagnosis indicating long-term NSAID use. To describe use of NSAID among patients with T2DM, we reported proportions of patients claiming at least 1, 2, 3 or 4 prescriptions of NSAID within one year of start of follow-up. We investigated associations between use of NSAIDs (celecoxib, diclofenac, ibuprofen and naproxen) and new-onset HF hospitalizations using a case-crossover design with 28-day exposure windows and reported odds ratios (OR) with 95% confidence intervals (CI). The case-crossover design uses each individual as his or her own control making it suitable to study the effect of short-term exposure on immediate events while mitigating unmeasured confounding. Sensitivity analyses using exposure windows of 14 and 42 days were performed as well. Results A total of 334,950 patients with T2DM was included (47.7% female, median age of 61 [interquartile range 50–70]). Celecoxib and naproxen were rarely used; on the contrary, prescriptions of diclofenac and ibuprofen were claimed at least once within one year from the beginning of follow-up by 4.9% and 15.5% of patients, respectively–0.9% and 2.7% claimed at least four prescriptions (Figure 1). The risk of new-onset HF hospitalization was increased following use of diclofenac or ibuprofen with corresponding ORs of 1.3 (95% CI 1.0 to 1.7) and 1.3 (95% CI 1.1 to 1.5) using 28-day exposure windows. An increased risk following use of celecoxib or naproxen was not found (Figure 2). Conclusion NSAIDs diclofenac and ibuprofen were both widely used and associated with an increased risk of new-onset HF hospitalization in patients with T2DM. This suggests a previously unknown and serious, clinically relevant concern of NSAID use in patients with T2DM. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Ib Mogens Kristiansens Almene FondHelsefonden

ПРИМЕНЕНИЕ НЕСТЕРОИДНЫХ ПРОТИВОВОСПАЛИТЕЛЬНЫХ ПРЕПАРАТОВ ПРИ ПАРОДОНТАЛЬНОЙ ТЕРАПИИ ПАЦИЕНТОВ С КОМОРБИДНОЙ ПАТОЛОГИЕЙ

Subject. This paper covers the main aspects of non-steroidal anti-inflammatory drugs (NSAIDs) used on periodontal therapy in patients with cormobid pathology.&#x0D; Objectives. A domestic and foreign literature review on effects of NSAIDs on periodontal therapy in patients with cormobid pathology.&#x0D; Methodology. The literature review is based on the source literature available over the past five years starting 2015 by PubMed keywords in order to summarize the subject information.&#x0D; Conclusion. NSAIDs, therefore, remain the most essential medications on etiotropic, pathogenetic and symptomatic therapy of dental disorders. NSAIDs can help manage pain syndrome, control inflammation responses and regeneration with indulating inflammation-induced tissue destruction, prevent unnecessary complications during basic and supportive periodontal therapy including invasive techniques. Systemic and localized use of NSAIDs in the complex periodontal therapy based on the rational choice of the drug and the appropriate dose selection considering patient’s comorbidities must be necessarily supported by the dentist’s knowledge of pharmacodynamics and NSAIDs classifications with Clinical Guidance on rational use of NSAIDs (2015, revised 2018) and Clinical Guidance on comorbid pathology (2019) taken as the basis. These, therefore, will ensure the personified approach, efficacy and safety of NSAID use in patients.

Risk of Bleeding Associated With Nonsteroidal Anti-inflammatory Drug Use in Patients Exposed to Antithrombotic Therapy: A Case-Crossover Study.

Concomitant nonsteroidal anti-inflammatory drug (NSAIDs) and antithrombotic drug use is associated with an increased risk of bleeding, mainly gastrointestinal. The goal of this study was to quantify the transient increase in the risk of hospitalization for bleeding associated with NSAID use in patients treated with antiplatelet agents or anticoagulants. We performed a unidirectional case-crossover study using the EGB (Échantillon généraliste de bénéficiaires), a permanent random sample of the French nationwide health database. Patients receiving antithrombotic therapy and hospitalized for bleeding between 2009 and 2017 were included. We compared their NSAID exposure during a 15-day hazard window immediately before hospital admission to 3 earlier 15-day control windows. The risk of hospitalization for bleeding associated with the recent use of NSAIDs was estimated using conditional logistic regression to estimate odds ratios (ORs). During the study period, 33 patients treated with anticoagulants and 253 treated with antiplatelet agents received NSAIDs and were included in the case-crossover analysis. We found an increased risk of hospitalization for gastrointestinal bleeding after exposure to NSAIDs, with an adjusted OR of 3.59 (95%CI, 1.58-8.17) in patients receiving anticoagulant therapy and 1.44 (95%CI, 1.07-1.94) in patients receiving antiplatelet therapy. The risk of nongastrointestinal bleeding was also increased after exposure to NSAIDs with an adjusted OR of 2.72 (95%CI, 1.23-6.04) in patients exposed to anticoagulant therapy. The risk of gastrointestinal and nongastrointestinal bleeding increases after NSAID use in patients treated with anticoagulants, while the risk of gastrointestinal bleeding increases, but to a lesser extent in those treated with antiplatelets.

Лечение пациентов со скелетно-мышечным болевым синдромом в период пандемии COVID-19

Objective of the Review: To discuss the efficiency and safety of the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with low back pain (LBP), also during COVID-19 pandemic. Key Points. Musculoskeletal pain syndromes, including LBP, are common; they affect the quality of patients’ life and result in huge medical bills. In a lot of post-COVID-19 patients, LBP appears for the first time or gets worse. Challenges in the management of such patients are caused by involvement of multiple organs and body systems, the need in taking numerous medications at once, which increases the risk of drug interaction. This overview describes the efficiency and safety of nimesulide in patients with low back pain. The use of NSAIDs in patients with COVID-19 is discussed. Beneficial effects and possible risks of nimesulide are analysed. Conclusion. Management of patients with LBP during the COVID-19 pandemic requires thorough selection of an optimal therapy taking into account comorbidities and a high risk of drug-drug interactions. Nimesulide is a potent medication with a favourable safety and tolerability profile. It is advisable to use nimesulide in the management of patients with low back pain, including COVID-19 survivors. Safety of the therapy can be ensured by thorough drug selection taking into account comorbidities and risks of complications. Keywords: musculoskeletal pain syndromes, low back pain, COVID-19, post-COVID syndrome, nonsteroidal anti-inflammatory drugs, nimesulide, management, side effects.

The risk of mortality in patients with COVID-19 with pre-diagnosis use of NSAIDs: a meta-analysis.

The notion that the use of non-steroidal anti-inflammatory drugs (NSAIDs) may lead to adverse outcomes upon acquisition of coronavirus disease 2019 (COVID-19) should be discredited with a review of the real-life evidence. We aimed to perform a meta-analysis to summarize the risk of mortality with the preadmission/pre-diagnosis use of NSAIDs in patients with COVID-19. A systematic literature search was performed to identify eligible studies in electronic databases. The outcome of interest was the development of a fatal course of COVID-19. Adjusted hazard ratio or odds ratio/relative risk and the corresponding 95% confidence interval from each study were pooled using a random-effects model to produce pooled hazard ratio and pooled odds ratio, along with 95% confidence interval. The meta-analysis of 3 studies with a total of 2414 patients with COVID-19 revealed no difference in the hazard for the development of a fatal course of COVID-19 between NSAID users and non-NSAID users (pooled hazard ratio = 0.86; 95% confidence interval 0.49–1.51). Therefore, NSAIDs should not be avoided in patients who are appropriately indicated during the COVID-19 pandemic.

Burden of Renal Events Associated with Nonsteroidal Anti-inflammatory Drugs in Patients with Osteoarthritis and Chronic Low Back Pain: A Retrospective Database Study.

IntroductionNonsteroidal anti-inflammatory drugs (NSAIDs) have long-term benefits but are limited by side effects. We assessed the health and economic burden of renal events associated with NSAID use in patients with osteoarthritis (OA) and/or chronic low back pain (CLBP).MethodsThis retrospective, large-scale, medical claims database study of Japanese patients receiving NSAIDs for OA and/or CLBP between 2009 and 2018 assessed the incidence of renal events and effect of treatment duration, mode of administration, and usage consistency of NSAIDs.ResultsOf 180,371 patients, NSAIDs were prescribed as first-line analgesics in 89.3%. Incidence per 10,000 person-years (95% confidence interval [CI]) for renal events was 23.46 (21.84–25.08) and for progression of chronic kidney disease (CKD) was 267.12 (189.93–344.32). Longer treatment duration (> 1 to ≤ 3 years, risk ratio [RR] 1.32, 95% CI 1.12–1.54; P = 0.0007; > 3 to ≤ 5 years, RR: 1.38, 95% CI 1.04–1.84; P = 0.0254 vs. < 1 year) and consistent use (RR: 1.24, 95% CI 0.99–1.55; P = 0.0595) increased the risk of renal events but the latter did not reach statistical significance. The risk was similar in patients using patch/oral NSAIDs and high in elderly patients and in those with diabetes, hypertension, and other cardiovascular disease. Following a renal event, median 1-year cost of drug treatment was $27.90; hospitalization, $1779.40; and dialysis, $33,018.40.ConclusionsRisk of renal events significantly increased with prolonged and consistent NSAID use (irrespective of mode of administration), with age, and in patients with certain comorbidities. Careful NSAID use is recommended in patients with CKD and those at high risk for CKD.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40122-020-00233-w.

Associations Between the Use of Non-Steroidal Anti-Inflammatory Drugs and Adverse Outcomes Among Patients with COVID-19: A Systematic Review and Meta-Analysis

Background: There are concerns that the use of non-steroidal anti-inflammatory drugs (NSAIDs) may increase the risk of adverse outcomes in COVID-19 patients. Therefore, this study aimed to synthesize the existing evidence on associations between the use of NSAIDs and adverse outcomes among patients with COVID-19.Methods: Systematic search of WHO COVID-19 Database, Medline, The Cochrane Library, Web of Science, Embase, China Biology Medicine disc, China National Knowledge Infrastructure, and Wanfang Database for all articles published from January 1, 2020, to August 10, 2021, as well as a supplementary search of Google Scholar. We included comparative observational studies and randomized controlled trials that enrolled patients with COVID-19 who took NSAIDs before or after diagnosis of COVID-19. Data extraction and quality assessment of methodology of included studies were completed by two reviewers independently. We conducted a meta-anlysis on the main outcomes, as well as selected subgroup analyses stratified by the type of NSAID.Fingings: Fifteen non-randomized studies evaluating 24700 adult COVID-19 patients were identified. The use of NSAIDs in patients with COVID-19, compared with no use of NSAIDs, was not significantly associated with an elevated mortality (odds ratio [OR]=0.94, 95% confidence interval [CI]: 0.87 to 1.02), or an increased probability of ICU admission (OR=1.35, 95% CI: 0.73 to 2.49), requiring mechanical ventilation (OR=1.23, 95% CI: 0.71 to 2.13), or administration of supplemental oxygen (OR=0.99, 95% CI: 0.91 to 1.08). The subgroup analyses revealed that the use of ibuprofen (OR=1.22, 95% CI: 0.32 to 4.60), etoricoxib (OR=0.36, 95% CI: 0.02 to 6.49) or celecoxib (zero deaths in both groups) were not associated with an increased risk of death in COVID-19 patients, compared with not using any NSAID.Interpretation: Fever is one of the main clinical symptoms of COVID-19. According to our findings, NSAIDs such as ibuprofen can be used to treat fever in COVID-19 patients safely.Funding: None to declare. Declaration of Interest: None to declare.

Abstract 16229: Nonsteroidal Anti-inflammatory Drug Use and Heart Failure Hospitalizations: Are Patients Being Screened?

Introduction: There is strong evidence that nonsteroidal anti-inflammatory drugs (NSAIDs) increase the risk of heart failure (HF) and mortality in HF patients. Patients admitted with decompensated HF should be screened for NSAID use. Hypothesis: NSAID use in patients admitted with HF is often overlooked due to inadequate screening by clinicians. Methods: We performed a prospective study of all patients admitted to the cardiology service with a primary diagnosis of decompensated HF. All patients were evaluated for enrollment within 48 hours of admission. Exclusion criteria included shock, cardiac arrest, respiratory failure requiring positive pressure ventilation, altered mental status or toxic metabolic encephalopathy, dementia, cognitive deficit, acute gastrointestinal bleed, acute blood loss anemia, and NSAID allergy. Electronic Medical Record review and in-person interviews were performed to determine if subjects had been screened for NSAID use. Positive screening included: documentation of NSAID use or absence of NSAID use in the admission note, medication reconciliation documenting NSAID use, or answering yes to the interview question “Were you asked if you take NSAIDs or over-the-counter pain medication?” Results: The study included 151 subjects (78 men/73 women); mean age 71.7 years. The number of patients who were taking NSAIDs was 34 (22.5%); there was no variation in prevalence between genders. NSAID screening occurred in 15.9% of patients (24/151). Of those taking NSAIDs, 88.3% had not been screened by their providers and 29% had no documented etiology for their HF exacerbation or had documented HF of “unclear etiology.” 56% of patients taking NSAIDs had self-prescribed, while 44% reported prescription by a physician. 82% had been taking NSAIDs regularly for over 1 month. Additionally, of patients on NSAIDs, 53% had coronary artery disease, 56% had hypertension, and 50% had chronic kidney disease. Conclusions: Despite strong evidence that NSAIDs are harmful and contraindicated in many cardiovascular conditions, NSAID use in patients with HF is still prevalent. This study highlights the importance of vigilant screening by clinicians and the need for improved patient education on the risks associated with this class of medication.

Can NSAIDs Be Used Safely for Analgesia in Patients with CKD?: PRO

Nearly 60% of patients with CKD suffer pain. Of those patients with CKD who have pain, most rate their pain as moderate or severe in intensity. Undermanaged pain is associated with higher rates of mood disorders, maladaptive coping, and decreased quality of life for patients with CKD (1). In general, nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended as first-line for analgesia and also act as antipyretics and anti-inflammatory medications. Estimates indicate that 98 million patients annually are prescribed NSAIDs (2), which likely represents only a fraction of total use given widespread nonprescription access. Epidemiologic studies suggest that 70%–80% of all NSAID users consume over-the-counter products like ibuprofen or naproxen (3,4). In the National Health and Nutrition Examination Survey, routine NSAID use was common in patients with CKD and use increased with increasing CKD severity (3). NSAIDs have well-known adverse effects in CKD patients. These risks can broadly be categorized into affecting the kidneys, gastrointestinal (GI) tract, or cardiovascular system. Among these risks, it is the direct and indirect nephrotoxicity that has primarily led to hesitation with the use of NSAIDs in patients with CKD. In one study, patients with CKD were more likely to receive an opioid than an NSAID or gabapentinoid across the entire spectrum of CKD (5). The highest rates of opioid prescribing were in patients with the lowest GFR. Indirect nephrotoxicity from NSAIDs is linked to altered intraglomerular hemodynamics. NSAIDs inhibit PG synthesis, which decreases afferent arteriolar vasodilation and can reduce glomerular pressure. This is especially prominent in patients with already jeopardized renal perfusion as in shock or intravascular volume depletion. For this reason, use of NSAIDs in acutely ill patients with AKI, acute kidney disease, or in the midst of renal recovery remains ill-advised. Patterns of direct nephrotoxicity include interstitial nephritis, papillary necrosis, and …

Nonsteroidal Anti-inflammatory Drugs for Acute Low-back Pain.

Low back pain is a common reason for emergency department presentation and is a leading cause of acute disability. Up to 70% of individuals experience low back pain during their lifetime. Many patients recover from acute back pain within 6 weeks, but some patients experience multiple episodes or chronic pain.Guidelines recommend avoidance of bedrest, early activity, patient education, attention to patient psychosocial factors, and administration of analgesic medications. Clinical practice guidelines from the American College of Physicians recommend non-steroidal anti-inflammatory drugs (NSAIDs) as a treatment option due to their analgesic and anti-inflammatory properties.

Ketorolac after colectomy for ulcerative colitis: an analysis of narcotic use and post-operative complications

Background: Use of non-steroidal anti-inflammatory drugs (NSAIDs) remains controversial in patients with ulcerative colitis. Some evidence suggests NSAID use in patients with IBD may precipitate disease flares or increase surgical complications, and many clinicians prohibit their use. In the post-operative setting, ketorolac has been utilized to improve pain control since pathologic tissue has been removed. The clinical outcomes and narcotic requirements of children who receive ketorolac in …

Non-steroidal anti-inflammatory drugs in patients with stable ankylosing spondylitis receiving tumor necrosis factor inhibitor: continued vs withdrawn.

To investigate the effect of non-steroidal anti-inflammatory drugs (NSAIDs) on disease activity in patients with stable ankylosing spondylitis (AS) receiving tumor necrosis factor inhibitor (TNFi). In this retrospective observational study, a total of 189 patients with stable AS receiving TNFi were included. Patients were classified into NSAID withdrawn group (n = 48) and NSAID continued group (n = 141), according to the use of NSAIDs. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured every 3months, and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was measured every 6months as parameters to evaluate disease activity. ESR, CRP, and BASDAI at each time point, and time-averaged values of each parameter during the observation period of 1year were compared between the two groups. Repeated-measure ANOVA was performed to compare changes in disease activity parameters during the observation period between the two groups. The level of ESR, CRP, and BASDAI at baseline and during the observation period did not differ between the two groups. The time-averaged values of ESR (p = 0.096), CRP (p = 0.136), and BASDAI (p = 0.421), and changes of ESR (p = 0.101), CRP (p = 0.714), and BASDAI (p = 0.613) during the observation period were not significantly different between the two groups. The continued use of NSAIDs in patients with stable AS receiving TNFi had no additional benefit in controlling the disease activity, as compared to patients who withdrew NSAIDs. Considering the risk of toxicity of long-term NSAID use, withdrawal of NSAIDs in stable AS patients receiving TNFi may be preferable. Key points • There is a lack of supportive evidence whether to continue or withdraw non-steroidal anti-inflammatory drugs (NSAIDs) in patients with stable ankylosing spondylitis (AS) receiving tumor necrosis factor inhibitor (TNFi). • Compared with patients who withdrew NSAIDs, continuing NSAIDs in patients with stable AS receiving TNFi had no additional benefit in controlling disease activity. • The results of the present study provide evidence that supports withdrawal of NSAIDs in patients with stable AS receiving TNFi.