Pennsaid, a new local treatment for arthritis
[October 8, 2003 - St.John Telegraph Journal]
Dr. Kenneth Walker
Elephants normally win when fighting a mouse. But for once the mouse
has won. A Canadian company has beaten the U.S. and achieved an historic
first. Dimethaid Research has developed a non-oral NSAID (non-steroidal
anti-inflammatory drug) to treat osteoarthritis. And since it's locally
applied, it dramatically reduces the risk of stomach complications
associated with oral NSAIDs.
It's estimated that three million Canadians suffer from osteoarthritis.
It's the wear-and-tear type of arthritis which presents a challenge for
patients day after day. Some people have had to give up a favourite sport
gardening or taking their daily walk. Others find it increasingly difficult
to navigate the stairs or carry out household chores. Today, with an aging
population, there's a huge need for this safe and effective remedy.
Dr. Peter Tugwell, Professor of Medicine at the University of Ottawa,
recently presented his findings on Pennsaid to the European Congress of
Rheumatology in Lisbon, Portugal.
The study was conducted on 622 Canadian patients suffering from knee
osteoarthritis. The purpose was to compare Pennsaid with the maximum daily
dose of oral diclofenac, a nonsteroidal anti-inflammatory drug.
Researchers found Pennsaid was as effective as the oral dose of NSAID
in relieving pain and the physical impairment of arthritis. And since it's
applied locally, there is much less likelihood of the complications
associated with oral NSAIDs.
Why is Pennsaid such an historic event? For years, the standard
treatment of arthritis has been the use of oral NSAIDs. They have helped
millions of patients in North America. But treating arthritis with them has
always been a risky affair. Every year, 1,900 Canadians die from the
complication of these drugs.
It's a worldwide problem. A study in the United Kingdom used an
optical instrument to examine the stomachs of patients using the older
NSAIDs. The results were shocking. Doctors reported that after two months
of use, one in five patients had a stomach ulcer without symptoms, one in 70
a painful ulcer, one in 150 a bleeding ulcer, one in 1,200 died from a
gastric hemorrhage.
In a Danish study, researchers tracked 207,000 people for 19 years who
had been on NSAIDs to determine the extent of intestinal bleeding. It
showed that NSAIDs increased the risk of bleeding five times. For those
over 75 years of age, the risk was 27 times greater. And in the U.S.,
107,000 people are hospitalized every year due to the intestinal
side-effects of NSAIDs and 16,500 die. It's a huge price to pay for pain
relief.
But in addition to life threatening complications, many patients using
oral NSAIDs complain of abdominal pain, dyspepsia, nausea, diarrhea and
there may be abnormalities in liver function tests.
This happens because the early NSAIDs destroyed an enzyme called COX-1,
which normally protects the stomach's lining from inflammation.
So researchers did the obvious thing. They designed new NSAIDs such as
Celebrex, Mobicox and Vioxx to preserve COX-1 and protect the stomach.
Studies show these NSAIDs are an improvement, but they have not eliminated
serious complications.
There is another aspect of NSAID medication that is rarely explained to
patients suffering from arthritis. I frequently see patients swallowing
NSAIDs as if they were like M&M candies. They have never been informed that
NSAIDs are powerful drugs that can have adverse effects on kidneys,
particularly aging ones.
The availability of a stomach-friendly NSAID fills a big void in
therapy. Initially, Pennsaid solution is applied onto the knee four times a
daily. Later, as the paid subsides, fewer daily applications may be
required. The most common side-effect involves a minor skin reaction at the
site of application.
Pennsaid will undoubtedly save lives and be a godsend for those
suffering from arthritis. But it will also help to save millions of dollars
spent treating the complications of oral NSAID medication. |
