условия использования материалов

Фармрынок / Pharm market

Роль НПВС в лечении ОА: новые данные / The role of NSAIDs in the treatment of OA: new data

DOI: http://dx.doi.org/10.21518/1561-5936-2020-7-8-29-32

Алексей Водовозов, врач-терапевт высшей категории, «Ремедиум»

Современная терапия остеоартрозов любых локализаций строится по принципу максимально возможного учета интересов пациента, в том числе за счет тщательного выстраивания баланса пользы, подтвержденной в строгом соответствии с принципами доказательной медицины, и потенциального вреда за счет нежелательных побочных эффектов применяемых ЛС. НПВС при этом по праву заняли место препаратов выбора, однако долгое время акцент делался на системном их применении, на пероральных формах. Новые рекомендации Американского колледжа ревматологии (ACR) и Международного общества по изучению остеоартроза (OARSI) смещают центр тяжести в сторону топических формы, ориентируясь на актуальные данные об их эффективности и безопасности. При этом от ряда ранее применявшихся средств, например, хондропротекторов, рекомендовано отказаться.

Alexey Vodovozov, physician of superior expert category, Remedium

Modern therapy for osteoarthritis of any localization follows the principle on integrating patients’ concerns as much as possible, including thorough building of balance of benefits confirmed in strict accordance with the principles of evidence-based medicine, and potential harm due to unwanted side effects of the drugs used. In this case, NSAIDs gained a rightful place of drugs of choice, but the emphasis was placed on their systemic use, on oral forms for a long time. The new guidelines from the American College of Rheumatology (ACR) and the Osteoarthritis Research Society International (OARSI) are shifting the center of balance towards topical forms, focusing on current evidence of their effectiveness and safety. At the same time, it is recommended to refuse some previously used agents, for example, chondroprotectors.

Источники

1. Cisternas M.G., Murphy L., Sacks J.J., Solomon D.H., Pasta D.J., Helmick C.G. Alternative methods for defining osteoarthritis and the impact on estimating prevalence in a US population-based survey. Arthritis Care Res (Hoboken). 2016;68:574–580. 

2. GBD 2015 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1603–1658.

3. Murphy L., Schwartz T.A., Helmick C.G., Renner J.B., Tudor G., Koch G. et al. Lifetime risk of symptomatic knee osteoarthritis. Arthritis Rheum. 2008;59:1207–1213. 

4. Murphy L.B., Helmick C.G., Schwartz T.A., Renner J.B., Tudor G., Koch G.G. et al. One in four people may develop symptomatic hip osteoarthritis in his or her lifetime. Osteoarthritis Cartilage. 2010;18:1372–1379. 

5. Qin J., Barbour K.E., Murphy L.B., Nelson A.E., Schwartz T.A., Helmick C.G. et al. Lifetime risk of symptomatic hand osteoarthritis: the Johnston County Osteoarthritis Project. Arthritis Rheumatol. 2017;69:1204–1212. 

6. Nuesch E., Dieppe P., Reichenbach S., Williams S., Iff S., Juni P. All cause and disease specific mortality in patients with knee or hip osteoarthritis: population based cohort study. BMJ. 2011;342:d1165. doi: 10.1136/bmj.d1165. 

7. Хитров Н.А. Остеоартроз. Медицинский совет. 2011;(11– 12):132–139. 

8. Kolasinski S.L., Neogi T., Hochberg M.C. et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res (Hoboken). 2020;72(2):149–162. doi: 10.1002/ acr.24131. 

9. Bannuru R.R., Osani M.C., Vaysbrot E.E. et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019;27(11):1578–1589. doi: 10.1016/j.joca.2019.06.011. 

10. Rannou F., Pelletier J.P., Martel‐Pelletier J. Efficacy and safety of topical NSAIDs in the management of osteoarthritis: evidence from real‐life setting trials and surveys. Semin Arthritis Rheum. 2016;45(Suppl.):18–21. 

11. Wadsworth L.T., Kent J.D., Holt R.J. Efficacy and safety of diclofenac sodium 2% topical solution for osteoarthritis of the knee: a randomized, double-blind, vehicle-controlled, 4 week study. Curr Med Res Opin. 2016;32(2):241. 

12. Rannou F., Pelletier J.P., Martel-Pelletier J. Efficacy and safety of topical NSAIDs in the management of osteoarthritis: evidence from real-life setting trials and surveys. Semin Arthritis Rheum. 2016;45(4 Suppl.):18–21. doi: 10.1016/j.semarthrit.2015.11.007. 

13. Lin J., Zhang W., A. Jones, M. Doherty. Efficacy of topical nonsteroidal anti-inflammatory drugs in the treatment of osteoarthritis: meta-analysis of randomised controlled trials. BMJ. 2004;329(7461):324. doi: 10.1136/bmj.38159.639028.7C. 

14. Sardana V., Burzynski J., Zalzal P. Safety and efficacy of topical ketoprofen in transfersome gel in knee osteoarthritis: a systematic review. Musculoskeletal Care. 2017;15(2):114–121. doi: 10.1002/msc.1163. 

15. Derry S., Conaghan P., Da Silva J.A., Wiffen P.J., Moore R.A. Topical NSAIDs for chronic musculoskeletal pain in adults. Cochrane Database Syst Rev. 2016;(4):CD007400. doi: 10.1002/14651858.CD007400.pub3. 

16. Derry S., Wiffen P.J., Kalso E.A., Bell R.F., Aldington D., Phillips T. et al. Topical analgesics for acute and chronic pain in adults - an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2017;(5):CD008609. doi: 10.1002/14651858.CD008609.pub2. 

17. Zeng C., Wei J., Persson M.S.M., Sarmanova A., Doherty M., Xie D. et al. Relative efficacy and safety of topical non-steroidal anti-inflammatory drugs for osteoarthritis: a systematic review and network meta-analysis of randomised controlled trials and observational studies. Br J Sports Med. 2018. doi: 10.1136/bjsports-2017-098043. 

18. Chou R., McDonagh M.S., Nakamoto E., Griffin J. Analgesics for Osteoarthritis: An Update of the 2006 Comparative Effectiveness Review. Rockville (MD): Agency for Healthcare Research and Quality (US); 2011. 

19. Honvo G., Leclercq V., Geerinck A., Thomas T., Veronese N., Charles A. et al. Safety of topical non-steroidal anti-inflammatory drugs in osteoarthritis: outcomes of a systematic review and meta-analysis. Drugs Aging. 2019;36(Suppl. 1):45–64. doi: 10.1007/ s40266-019-00661-0. 

20. Chan F.K., Ching J.Y., Tse Y.K., Lam K., Wong G.L., Ng S.C. et al. Gastrointestinal safety of celecoxib versus naproxen in patients with cardiothrombotic diseases and arthritis after upper gastrointestinal bleeding (CONCERN): an industry independent, double‐blind, double‐dummy, randomised trial. Lancet. 2017;389:2375–2382. 

21. Nissen S.E., Yeomans N.D., Solomon D.H., Lüscher T.F., Libby P., Husni M.E. et al. for the PRECISION Trial Investigators. Cardiovascular safety of celecoxib, naproxen, or ibuprofen for arthritis. N Engl J Med. 2016;375:2519–2529. 

22. Solomon D.H., Husni M.E., Libby P.A., Yeomans N.D., Lincoff A.M., Lüscher T.F. et al. The risk of major NSAID toxicity with celecoxib, ibuprofen, or naproxen: a secondary analysis of the PRECISION trial. Am J Med. 2017;130:1415–1422. 

23. Nissen S.E., Yeomans N.D., Solomon D.H., Lüscher T.F., Libby P., Husni M.E. et al. Cardiovascular safety of celecoxib, naproxen, or ibuprofen for arthritis. N Engl J Med. 2016;375(26):2519e29. 

24. Runhaar J., Rozendaal R.M., van Middelkoop M., Bijlsma H.J., Doherty M., Dziedzic K.S. et al. Subgroup analyses of the effectiveness of oral glucosamine for knee and hip osteoarthritis: a systematic review and individual patient data meta‐analysis from the OA trial bank. Ann Rheum Dis. 2017;76:1862–1869. 

25. Wandel S., Jüni P., Tendal B., Nüesch E., Villiger P.M., Welton N.J. et al. Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta‐analysis. BMJ. 2010;341:4675. 

26. Clarke T.C., Black L.I., Stussman B.J., Barnes P.M., Nahin R.L. Trends in the use of complementary health approaches among adults: United States, 2002–2012. Natl Health Stat Report. 2015;1–16. 

27. Biggee B.A., Blinn C.M., Nuite M., Silbert J.E., McAlindon T.E. Effects of oral glucosamine sulphate on serum glucose and insulin during an oral glucose tolerance test of subjects with osteoarthritis. Ann Rheum Dis. 2007;66:260–262. 

28. Santos G.R., Piquet A.A., Glauser B.F., Tovar A.M., Pereira M.S., Vilanova E. et al. Systematic analysis of pharmaceutical preparations of chondroitin sulfate combined with glucosamine. Pharmaceuticals (Basel). 2017;10(2). doi: 10.3390/ph10020038.

Ключевые слова: ACR, OARSI, остеоартроз, НПВС, хондропротекторы, клинические рекомендации, вольтарен, топические формы, osteoarthritis, NSAIDs, chondroprotectors, clinical guidelines, voltaren, topical forms

Вернуться назад

Архив номеров
Archive of "Remedium"

2020   2019    2018   2017   2016  2015    2014    2013    2012   2011   2010   2009   2008   2007   2006  2005    2004   2003

© Remedium 2014-2021
Все права защищены