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      Perceptions and Beliefs Regarding NSAIDs in the Asia-Pacific Region

      1

      Journal of Pain Research

      Dove

      cardiovascular, COX-2 inhibitors, efficacy, gastrointestinal, renal, respiratory

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          Abstract

          Background

          Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used in the treatment of pain and inflammation. However, chronic NSAID use may result in gastrointestinal (GI), cardiovascular (CV), renal or other safety concerns, especially in high-risk populations. The aim of this review is to systematically identify relevant literature and to organize available evidence for perceptions or beliefs of physicians and patients about the safety and efficacy of NSAIDs.

          Methods

          A systematic literature search was conducted in MEDLINE ® (through PubMed ®), Embase ® (through Ovid ®), and the Cochrane Library. Additional unstructured searches were conducted using Google Scholar™ and Google. The scope of this study did not include grey literature searches or handpicking of cross references. This systematic analysis was conducted with a special interest in studies conducted in the Asia-Pacific (APAC) region and information related to the COX-2 (cyclooxygenase-2) selective inhibitors.

          Results

          Out of a total of 2822 studies retrieved from different databases (PubMed ®, Cochrane, Google Scholar™ and Embase ®), 99 (3.5%) met the inclusion criteria. Further, out of these 99 studies, 23 APAC region studies were analyzed. The common perceptions were related to GI, CV, renal and respiratory safety, efficacy and COX-2 inhibitors.

          Conclusion

          Overall, the level of awareness among patients regarding NSAIDs was observed to be considerably poor. Moreover, risk stratification by physicians must be practiced in order to decrease the incidence of adverse events.

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          Most cited references 25

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          Randomized trial of switching from prescribed non-selective non-steroidal anti-inflammatory drugs to prescribed celecoxib: the Standard care vs. Celecoxib Outcome Trial (SCOT)

          Background Selective cyclooxygenase-2 inhibitors and conventional non-selective non-steroidal anti-inflammatory drugs (nsNSAIDs) have been associated with adverse cardiovascular (CV) effects. We compared the CV safety of switching to celecoxib vs. continuing nsNSAID therapy in a European setting. Method Patients aged 60 years and over with osteoarthritis or rheumatoid arthritis, free from established CV disease and taking chronic prescribed nsNSAIDs, were randomized to switch to celecoxib or to continue their previous nsNSAID. The primary endpoint was hospitalization for non-fatal myocardial infarction or other biomarker positive acute coronary syndrome, non-fatal stroke or CV death analysed using a Cox model with a pre-specified non-inferiority limit of 1.4 for the hazard ratio (HR). Results In total, 7297 participants were randomized. During a median 3-year follow-up, fewer subjects than expected developed an on-treatment (OT) primary CV event and the rate was similar for celecoxib, 0.95 per 100 patient-years, and nsNSAIDs, 0.86 per 100 patient-years (HR = 1.12, 95% confidence interval, 0.81–1.55; P = 0.50). Comparable intention-to-treat (ITT) rates were 1.14 per 100 patient-years with celecoxib and 1.10 per 100 patient-years with nsNSAIDs (HR = 1.04; 95% confidence interval, 0.81–1.33; P = 0.75). Pre-specified non-inferiority was achieved in the ITT analysis. The upper bound of the 95% confidence limit for the absolute increase in OT risk associated with celecoxib treatment was two primary events per 1000 patient-years exposure. There were only 15 adjudicated secondary upper gastrointestinal complication endpoints (0.078/100 patient-years on celecoxib vs. 0.053 on nsNSAIDs OT, 0.078 vs. 0.053 ITT). More gastrointestinal serious adverse reactions and haematological adverse reactions were reported on nsNSAIDs than celecoxib, but more patients withdrew from celecoxib than nsNSAIDs (50.9% patients vs. 30.2%; P < 0.0001). Interpretation In subjects 60 years and over, free from CV disease and taking prescribed chronic nsNSAIDs, CV events were infrequent and similar on celecoxib and nsNSAIDs. There was no advantage of a strategy of switching prescribed nsNSAIDs to prescribed celecoxib. This study excluded an increased risk of the primary endpoint of more than two events per 1000 patient-years associated with switching to prescribed celecoxib. Clinical Trial Registration https://clinicaltrials.gov/show/NCT00447759; Unique identifier: NCT00447759.
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            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

            Present guidelines are conflicting for patients at high risk of both cardiovascular and gastrointestinal events who continue to require non-steroidal anti-inflammatory drugs (NSAIDs). We hypothesised that a cyclooxygenase-2-selective NSAID plus proton-pump inhibitor is superior to a non-selective NSAID plus proton-pump inhibitor for prevention of recurrent ulcer bleeding in concomitant users of aspirin with previous ulcer bleeding.
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              Physicians' communication of risks from non-steroidal anti-inflammatory drugs and attitude towards providing adverse drug reaction information to patients.

              Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently prescribed for orthopaedic conditions, therefore this study aimed to explore orthopaedic physicians' perceptions of their role in NSAID-risk communication, their attitudes towards the necessity of informing patients about adverse drug reactions (ADR), and factors associated with these.
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                JPR
                jpainres
                Journal of Pain Research
                Dove
                1178-7090
                21 February 2020
                2020
                : 13
                : 437-446
                Affiliations
                [1 ]The Pain Clinic, Mount Alvernia Hospital , Singapore
                Author notes
                Correspondence: Kok-Yuen Ho The Pain Clinic, Mount Alvernia Hospital , 820 Thomson Road – 07-59, 574623, SingaporeTel/Fax +65 6 254 5447 Email drho@thepainclinic.com.sg
                Article
                229387
                10.2147/JPR.S229387
                7041596
                © 2020 Ho.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 2, Tables: 3, References: 29, Pages: 10
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