NSAID Use In Patients Research Articles

Prudent use of NSAIDs in patients with COVID-19, Dengue, and Chikungunya

NSAIDs are most common pharmacological options for pain management, although their use is questionable in many viral diseases like COVID-19, Dengue, and Chikungunya. Newer studies suggest to limit their use in such cases and also reinforces more careful considerations in patients with liver and kidney injuries or concurrent administration with other drugs/nutraceuticals such as antioxidants or SSRIs.

Prudent use of NSAIDs in patients with COVID-19, Dengue, and Chikungunya

Prudent use of NSAIDs in patients with COVID-19, Dengue, and Chikungunya

Prudent use of NSAIDs in patients with COVID-19, Dengue, and Chikungunya

Prudent use of NSAIDs in patients with COVID-19, Dengue, and Chikungunya

Применение инъекционного коллагена при остеоартрите у мультиморбидных пациентов

It has been established that osteoarthritis (OA) refers to diseases with high comorbidity. According to available data, OA is most often combined with arterial hypertension (AH) and other cardiovascular diseases (CVD). The combination of OA and CVD causes certain difficulties when choosing drug therapy. Traditionally, with pain syndrome, the choice falls on NSAIDs, since this allows in most cases to get a quick response to treatment. However, the use of NSAIDs may be accompanied by an increase in average blood pressure by 5 mm Hg or more in patients with arterial hypertension (AH) and significantly reduces the antihypertensive effectiveness of beta-blockers and ACE inhibitors. Symptomatic effect of the use of symptom-modifying drugs of delayed action (SYSADOA - Symptomatic slow acting drugs for osteoarthritis) develops approximately 8-12 weeks after the start of administration. Limitations in the use of NSAIDs in patients with OA and CVD due to increased cardiovascular risk and a long waiting period for the onset of the effect when using drugs of the SYSADOA group dictate the need to search for new approaches in the treatment of OA, on the one hand, with rapid effectiveness, and on the other - meeting all the requirements of cardiovascular safety. It is known that local injection therapy with the use of different groups of drugs has high efficiency in OA: glucocorticosteroids (GCS), hyaluronic acid, chondroitin, etc. Currently, microinduction collagen preparations with a high safety profile have joined them. Special attention in OA deserves the drug Plexatron, which has in its composition a type 1 tropocollagen with a molecular weight of 300 kD and calcium phosphate 1 mcg, and is intended for intra-articular and periarticular administration. Injectable collagen preparations are capable of inducing the regeneration of damaged collagen fibers by stimulating the migration of fibroblasts to the sites of damage, the release of growth factors and the activation of a key enzyme for the induction of endogenous collagen synthesis - lysine hydroxylase

Perioperative NSAID use in single level microdiscectomy and hemilaminectomy

The opioid crisis is a global issue and reduction of perioperative opioid use is paramount to help resolve the crisis. In this study. we investigated the prescribing habits of doctors in a single institution following a single level microdiscectomy or hemilaminectomy and the effect on discharge opioid medications and if the concurrent use of NSAIDs affected opioid use in this patient population. Between Jan 2016 and June 2021, 238 patients underwent either a microdiscectomy or hemilaminectomy. 131 patients received NSAIDs in the perioperative period and 107 did not. Use of NSAIDs was found to be associated with a shorter length of stay (2.6 vs 3.0 days, p = 0.014). Use of NSAIDs was associated with reduced opioid use at outpatient review, however, this was not statistically significant. NSAID use in this population did not result in any clinically significant adverse effects.In patients undergoing single level microdiscectomy and hemilaminectomy, use of NSAIDs is safe and associated with a reduced length of stay. Further qualitative randomised controlled trials are required to validate the efficacy of opioid reduction with NSAID use in patients undergoing single level microdiscectomies and hemilaminectomies.

Abstract 17289: NSAID Use and Clinical Outcomes in COVID-19

Introduction: There have been concerns that NSAID use may worsen outcomes in coronavirus disease 2019 (COVID-19) through upregulation of the ACE2 receptor used by the SARS-CoV-2 virus for cell entry. Hypothesis: We sought to determine whether prior use of NSAIDs in patients hospitalized with COVID-19 is associated with worse in-hospital outcomes. Methods: The Michigan Medicine Covid-19 Cohort (M 2 C 2 ) is an ongoing prospective observational study in which detailed clinical, laboratory and outcomes data were collected from chart review of consecutive adult patients hospitalized for COVID-19. Patients who were positive for SARS-CoV-2 infection but without symptoms of COVID-19 were not included in this cohort. We identified 553 patients who presented to University of Michigan Hospital between March 1 st and May 1 st for COVID-19, of whom 519 had data on whether they took NSAIDs prior to hospitalization. We examined the association between NSAID use and outcomes during their hospitalization. Results: 52 (10.0%) patients were taking NSAIDs prior to hospitalization (NSAID group; mean age 55.8 [SD 15.2]; 46.2% men) and 467 (90.0%) were not taking NSAIDs (non-NSAID group; mean age 61 [SD 16.0]; 57.7% men). There was no significant difference between the inflammatory markers on presentation to hospital between groups including CRP (median 8.0 vs median 9.7, p-value 0.79), procalcitonin (median 0.18 vs median 0.21, p-value 0.66), d-dimer (median 0.90 vs median 1.25, p-value 0.12), and IL-6 (median 36.7 vs median 49.3, p-value 0.43). All-cause mortality was not significantly different between the NSAID and non-NSAID groups (11.5% vs 16.8%, p-value 0.36) and neither was the risk of ICU admission (46.2% vs 48.9%, p-value 0.62). Conclusions: Among patients presenting to hospital with COVID-19, prior use of NSAIDs was not associated with significantly different levels of inflammatory markers on admission and was also not associated with significantly different mortality or rates of ICU admission.

The Comparative Efficacy and Safety of Long- and Short-Term Continuous Use of Non-Steroidal Anti-Inflammatory Drugs for the Treatment of Knee Osteoarthritis

Objective. To compare the efficacy and tolerability of long-term and short-term continuous NSAIDs in patients with knee osteoarthritis with insufficient efficacy “on demand” NSAIDs and SYSADOA.Study design. 12-week, prospective, comparative, randomized, single-center study.Materials and Methods. 180 patients with primary knee osteoarthritis aged 40 to 85 years with insufficient efficacy of “on demand” NSAIDs and SYSADOA were examined. Anti-inflammatory drugs were recommended for everyone: 56 people took Naproxen (31.11%), 63 — Etoricoxib (35%), 61 — Ketoprofen (33.89%). Patients were randomized into two groups: 1st group — with 8-week continuous intake of NSAIDs, 2nd group — with a 2-week continuous course of NSAIDs.Results. There was a positive dynamics of pain syndrome according to VAS and decrease in the level of the WOMAC index in both groups after 2 weeks of therapy. The pain level (VAS) and WOMAC indices in 1st group achieved after 8 weeks significantly differed from the ones after 2 weeks of therapy (VAS dynamics —10.93±2.43 mm, t = 42.64; p0.001). In both groups we noted gradual significant increase in the average pain level according to VAS and WOMAC indices after NSAIDs cancellation. However, there was better control of pain in 1st group with long-term NSAID than in 2nd one. Safety profile of drug therapy was similar in both groups.Conclusion. The long-term 8-week use of NSAIDs in patients with knee osteoarthritis with insufficient efficacy “on demand” NSAIDs and SYSADOA provides better dynamics of the pain syndrome than with 2-week therapy. After treatment is canceled longer prior NSAID therapy contributes to better control of the pain syndrome. Continuous use of NSAIDs demonstrated good tolerance and safety, did not require dose reduction and/or discontinuation of therapy. Thus, anti-inflammatory therapy of osteoarthritis in this group of patients may be prescribed for a longer period with continuous use of NSAIDs.

Navigating NSAID Use in Patients Receiving Oral Anticoagulation: Is There a Safe Course?

Navigating NSAID Use in Patients Receiving Oral Anticoagulation: Is There a Safe Course?

Abstract 1779: Chronic NSAID use increases survival in PIK3CA-altered head and neck squamous cell carcinoma

Abstract Background: PIK3CA is the most commonly altered oncogene in head and neck squamous cell carcinoma (HNSCC). Chronic non-steroidal anti-inflammatory (NSAID) use has been shown to reduce mortality in PIK3CA-mutated colorectal cancer through an unknown mechanism. In this retrospective cohort analysis, we evaluated the impact of NSAIDs on HNSCC survival, and sought a biologically plausible explanation for the observed effect. Methods: The PIK3CA status of tumor tissue was determined by FISH and next generation sequencing for 266 HNSCC patients treated at the University of Pittsburgh Cancer Institute. Cox joint proportional hazards models were used to generate multivariate projections of disease-specific (DSS) and overall survival (OS). Prostaglandin E2 (PGE2) secretion and NSAID sensitivity were then assessed in HNSCC cell lines with or without PIK3CA mutation. Results: Chronic NSAID use (≥2 days/week for ≥6 months) was associated with greater disease-specific (HR 0.24; 95% CI, 0.09 - 0.62; p = 0.0032) and overall survival (HR 0.31; 95% CI, 0.14 - 0.69; p = 0.0043) in patients whose tumors harbor PIK3CA mutation and/or amplification. Survival was unchanged by chronic NSAID use in patients with wild-type, unamplified PIK3CA. Chronic NSAID users with PIK3CA-altered tumors had an increase in estimated 5-year DSS from 25% to 72% and in OS from 45% to 78%. Benefit was independent of age, stage, and human papillomavirus (HPV) status; all of which were controlled for in the model. HNSCC cells with endogenous or engineered PIK3CA mutation secreted higher levels of PGE2 and were more sensitive to growth inhibition by NSAID treatment. Conclusions: Chronic NSAID use was associated with markedly improved survival in patients with PIK3CA-altered HNSCC, but not in those with wild-type, unamplified PIK3CA. Preclinical studies implicate the PI3K-COX-PGE2 signaling axis as a potential mediator of NSAID response. A prospective, randomized controlled trial of NSAIDs in patients with PIK3CA-altered HNSCC is warranted. Citation Format: Matthew Louis Hedberg, Noah Peyser, William Gooding, Hua Li, Toni Brand, Victor Olivas, Trever Bivona, Simion Choisea, Lin Wang, Jonas Johnson, Uma Duvvuri, Robert Ferris, Daniel Johnson, Patrick Ha, Julie Bauman, Jennifer Grandis. Chronic NSAID use increases survival in PIK3CA-altered head and neck squamous cell carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 1779. doi:10.1158/1538-7445.AM2017-1779

CV risks of long-term NSAID use in patients with RA

CV risks of long-term NSAID use in patients with RA

Association of Nonsteroidal Anti-inflammatory Drug Use With Stroke Among Dialysis Patients

IntroductionLimited studies have evaluated risk of stroke associated with the use of NSAIDs in patients with end-stage kidney disease. We examined the adverse effects of selective and nonselective NSAID use on the risk of stroke in dialysis patients.MethodsA case-crossover study was conducted using medical claims data from the National Health Insurance Research Database in Taiwan. We identified patients with ischemic and hemorrhagic stroke (defined as International Classification of Diseases, 9th revision, Clinical Modification codes 433, 434, and 436 for ischemic stroke and 430 and 431 for hemorrhagic stroke) from inpatient claims during the period from 2003 to 2012. Conditional logistic regression models with adjustment for potential confounders were used to determine the effects of NSAID use on stroke.ResultsA total of 1190 dialysis patients with stroke were identified from 2003 to 2012. The results indicate a 1.31-fold increased risk of stroke related to NSAID use during the 30 days prior to a stroke (AOR = 1.31; 95% CI: 1.03–1.66); likewise, an excessive risk of ischemic stroke was observed (AOR = 1.34; 95% CI: 1.02–1.77). When classifying NSAIDs into selective and nonselective groups, nonselective NSAID use was significantly associated with an increased risk of stroke (AOR = 1.27; 95% CI: 1.00–1.61).DiscussionIn summary, the results show supportive evidence that NSAID use increased the risk of stroke in dialysis patients, which suggests the importance of closely monitoring the transient effects of initial NSAID treatment to patients on dialysis.

Prehospital NSAIDs use prolong hospitalization in patients with pleuro-pulmonary infection

ObjectiveNonsteroidal anti-inflammatory drug (NSAID) pre-hospitalization consumption might affect the course of pneumonia. We opted to assess the potential effects of pre-hospitalization use of NSAIDs in patients with pleuropulmonary infection in the context of the duration of hospitalization. MethodsA prospective observational study of 57 consecutive patients with a diagnosis of pneumonia and parapneumonic pleural effusion was conducted. The exact medication history the previous fifteen days was recorded. ResultsPrehospital use of NSAIDs >6 days was positively associated with prolonged hospitalization extending out for approximately 10 days. Immunosuppression was an independent risk factor for prolonged hospitalization of more than 5 days. This group of patients also had more complicated pleural effusions and difficult to treat management. In the immunocompetent group of patients, there was a negative inverse correlation of duration of NSAIDs use with pleural fluid pH and glucose. The longer medication with NSAIDs correlated with lower values of C–reactive protein, and erythrocyte sedimentation rate. Importantly, the early prehospital antibiotic use significantly prevented the development of empyema. ConclusionOur findings highlight the potential complications involved with prehospital use of NSAIDs and especially that prolonged NSAID use which may lead to longer hospitalization duration and more complicated pleural effusions.

Our experience of bromfenac-containing NSAID use in patients after cataract surgery

Postoperative cystoid macular edema is an autoimmune reaction due to the blood-retinal barrier breakdown occurring at anterior segment inflammation. Aim: To analyze the effectiveness of various anti-inflammatory therapeutic schemes used in cataract surgery. Materials and methods. Phacoemulsification using similar consumables had been performed in 792 patients (932 eyes). They were divided into three groups: 1st group included patients receiving 1 to 3 dexamethasone (0.3 ml) and mesatone (0.1 ml) injections and Tobradex eye drops starting with 5 times a day for 4-5 weeks and then tapering (356 eyes); 2nd group (331 eyes) used eye drops of levofloxacin 0.5% solution and dexamethasone; and the 3rd group (325 eyes) in which instillations of ofloxacine and dexamethasone were combined with 0.09% eye drops solution of bromfenac (Broxinac) eye drops, the latter being prescribed QD for 2 days before and 16 days after surgery. Results. Treatment outcomes were less favorable in Group 1 (complications found in 15.2% of patients). Perioperative antibiotic eye drops of 0.5% levofloxacin solution provide a high level prevention of bacterial infection prevention after phacoemulsification. Patients treated with a combination of dexamethasone 0.1% solution eye drops and non-steroidal drug Broxinac had the lowest rate of postoperative inflammatory complications (7.0%).

Protocolo del manejo del dolor en Urgencias

It is important to address adequately and quickly pain in the emergency department. Pain characteristics serve to investigate the pathogenesis of the same and indicate the appropriate treatment. We should note the modified analgesic ladder WHO. Evaluating and monitoring the intensity of pain is recommended validated both the triage and subsequent developments scales. Patient comorbidities must be taken into account when choosing the right treatment. Avoid the use of NSAIDs in patients with renal insufficiency and used with caution in patients with cardiovascular risk or risk of bleeding. In case of severe pain it is advisable to administer potent opioids, but we must be cautious when prescribing opioid treatment at discharge, especially in cases of mild pain, and it is always advisable to outpatient follow-up. It is recommended to prevent possible side effects such as nausea and constipation.

NSAID Use in Patients With Barrettʼs Esophagus Increased the Severity of Reflux Esophagitis

NSAID Use in Patients With Barrettʼs Esophagus Increased the Severity of Reflux Esophagitis

Safety data prompt calls for a halt on NSAID use in patients with heart disease

Safety data prompt calls for a halt on NSAID use in patients with heart disease

Kidney disease, prostate cancer, and OTC products

The culprits Omeprazole and other PPIs. With the recent introduction of OTC esomeprazole magnesium (Nexium—P zer), three distinct proton pump inhibitor (PPI) medications and various generics are now available without a prescription. Many patients have positive outcomes with these medications without a physician appointment. However, there are risks to consider, and kidney disease is one that has been recently reported. A recent retrospective analysis of 133 cases of acute interstitial nephritis (AIN) found drugs to be the leading culprit in 70% of cases, and of those, omeprazole (Prilosec—AstraZeneca) was the causative agent in 12% of patients. Patients using omeprazole were older and had better baseline renal function and a longer duration of PPI use compared with cases of AIN not related to drug therapy.1 Similar data were found in a case control study in New Zealand.2 What does this mean in the self-care environment? Take advantage of opportunities to talk with patients about the appropriate way to use an OTC PPI, and discuss potential adverse reactions, including back pain, fever, blood in the urine, decreased urine output, and weight gain. NSAIDs. A number of studies have been published recently that discuss NSAID use in patients with kidney disease. In one study of 185 patients with chronic kidney disease, the authors determined how many took what was considered an inappropriate medication based on dosing recommendations in the package insert, which in turn were based on calculated creatinine clearance. More than 80% of those surveyed used at least one inappropriate medication, and of those, 66% were using an NSAID.3 When counseling patients on NSAID use, be sure to verify that the patient doesn’t have any type of renal dysfunction. Also, when dispensing medications that are commonly prescribed to patients with renal disease, counsel about the risks of using an OTC NSAID.

SAT0354 Nsaid Use in Patients with Ankylosing Spondylitis Treated with and without Tnf-Alpha Blocking Therapy during 2-Year Follow-Up in Daily Clinical Practice

BackgroundNon-steroidal anti-inflammatory drugs (NSAIDs) are regarded as the cornerstone of conventional therapy in ankylosing spondylitis (AS). TNF-α blocking therapy is available for AS patients who have insufficient response to conventional...

Time-perspective in cardiovascular risk of NSAID use after first-time myocardial infarction

Despite the fact that NSAIDs are not recommended among patients with established cardiovascular disease, many patients receive NSAID treatment for a short period of time. However, up until recently, data on the relationship between treatment duration and associated cardiovascular risk were sparse and have not been summarized. A series of recent studies of patients with prior myocardial infarction (MI) demonstrated that short-term treatment with most NSAIDs is associated with an increased cardiovascular risk relative to no NSAID treatment. These studies furthermore demonstrated that NSAID use among patients with first-time MI was associated with persistently increased risk of all-cause mortality and of a composite of coronary death or nonfatal recurrent MI for at least 5 years thereafter. The present review indicates that there is no apparent well-tolerated therapeutic window for associated cardiovascular risk and NSAID use in patients with prior MI. Further randomized studies are warranted to evaluate the cardiovascular safety of NSAIDs, but, at this point, the overall evidence suggests advising caution in using NSAIDs at all times after MI. Legislation bodies need to address this issue of public health proportions, as studies have shown that utilization rates of NSAID keep increasing.

Use of gastrointestinal prophylaxis in NSAID patients: a cross sectional study in community pharmacies

To assess the appropriateness of gastroprotective agents (GPA)\ NSAID use in patients' access medication through community pharmacy and the factors associated with any inappropriateness found. A cross-sectional study in which patients requesting NSAIDs through community pharmacy was undertaken. Information was collected through a structured questionnaire included data of patients' pharmacotherapy and gastropathy risk factors. Patients were classified as "overprotected" or "underprotected" according to the use of gastroprotective-drugs and presence/absence of gastropathy risk factors. We calculated the risk for under-or over-protection using logistic regression controlling for potential confounders. Twenty-seven community pharmacies of Southeast of Spain participated in the study. Out of 670 NSAID users recruited in the study, 243 (36.3%) were not appropriately protected: 197(81.1%) patients were underprotected, and 46 (18.9%) patients were overprotected. Compared to patients with ulcer history, patients with cardiovascular disease or chronic morbidity (aOR 18.55; 95% CI l 3.68-93.52, P < 0.001) and aged over 60 years (aOR 23.97; 95% CI 3.93-145.9) were associated with underuse of gastroprotective-drugs. OTC-NSAID-users were more likely to be underprotected than those with medical prescription (aOR 3.47; 95% CI l 1.84-6.55). Inappropriate GPA use is relatively frequent among NSAD users, especially in those using OTC-NSAIDs. Community pharmacists should be aware of factors contributing to NSAID-induced GI complications and assess its presence in the consumer when dispensing an OTC-NSAID.