New Canadian arthritis treatment recommendations released
For the first time, a topical NSAID deemed effective and safe for
osteoarthritis pain
MARKHAM, ON, Jan. 4 /CNW/ - New Canadian recommendations for prescribing
non-steroidal anti-inflammatories (NSAIDs) released this week include a new
option to manage osteoarthritis (OA) pain effectively and safely in the wake
of product recalls and warnings about traditional oral therapies to manage
arthritis pain.
An Evidence-based Approach to Prescribing NSAIDs: The Third Canadian
Consensus Conference was just published this month in the Journal of
Rheumatology, a monthly international peer-reviewed journal. The consensus
statement is the outcome of extensive research with stakeholders in the
arthritis community, a literature review, FDA and Health Canada panel
recommendations, and a meeting of health professionals and patient
representatives.
For the first time, the recommendations also suggest a topical
prescription NSAID therapy to treat OA symptoms in the knee. A new treatment
option, topical diclofenac or Pennsaid(R) is reported as a "reasonable
alternative or addition to therapy for patients who prefer a topical
treatment, are intolerant to oral medications, are insufficiently improved by
acetaminophen, or fall into high risk groups for the use of oral NSAIDs."
"These new treatment recommendations allow physicians to better navigate
the arthritis landscape in Canada, which has become quite bumpy in the last
12 months due to Health Canada warnings and product recalls. Many of the
medications under fire make the difference between productivity and disability
for people living in pain with OA," says Dr. Philip A. Baer, a clinical
rheumatologist practicing in Toronto, Ontario. "As part of the latest
evidence, a new topical treatment option called Pennsaid has been recommended
and endorsed for certain OA patients. Providing safer and effective
alternatives like Pennsaid to some of the 4 million Canadians living with
arthritis furthers my goal of helping them to live their lives to the
fullest."
These recommendations replace previous evidence-based recommendations for
the use of NSAIDs (including selective COX-2 inhibitors or coxibs) among
patients with OA and rheumatoid arthritis (RA) following the withdrawal of
Vioxx(R) and Bextra(R) from the market and subsequent warnings about other
selective COX-2 Inhibitors (coxibs) and traditional NSAIDs over the past year.
Despite the fact that selective COX-2 inhibitors continue to be heavily
scrutinized and some have been removed from the Canadian market, due to
questions of increased risk of heart attacks and stroke, selective
COX-2 inhibitors (coxibs) continue to be a treatment option, according to
guideline authors. However, the recommendations urge physician-patient
discussion on these medications, including risk and benefit, and routine
reassessment of patient risk.
The newest and latest addition of a topical therapy to the
recommendations is based on the results of three randomized controlled trials
suggesting Pennsaid(R) is as effective as oral diclofenac, considered the
"gold standard" treatment for OA, but with significantly fewer adverse events.
Demonstrated Efficacy
Pennsaid(R) is as effective as the maximum daily dose of comparable oral
medication at relieving pain and stiffness associated with OA of the knee, as
well as improving overall well-being according to a published study in the
Journal of Rheumatology by Tugwell et al. The randomized, controlled 12 week
trial in 622 patients with primary knee OA also showed that Pennsaid(R) led to
fewer gastrointestinal, renal and liver related side-effects(1).
An additional randomized and controlled study of 216 patients with
primary knee OA, published in BMC Musculoskeletal Disorders, showed that
Pennsaid(R) demonstrated relief at six weeks of the symptoms of primary OA of
the knee(2).
Pennsaid(R) improved pain scores by 45.7 per cent, physical function by
36.7 per cent, and stiffness by 35.1 per cent according to the results from a
randomized, controlled 12-week study published in the Archives of Internal
Medicine which enrolled 326 patients with knee OA. The findings demonstrated a
statistically significant difference over results from a control group that
received the chemical carrier alone, minus the active drug(3).
The most common adverse reaction associated with topically applied
Pennsaid(R) is dry or irritated skin at the application site.
Copies of the consensus guidelines can be found on the Journal of
Rheumatology web site at www.jrheum.com.
A Canadian solution
Currently in Canada, only one preparation of prescription topical
diclofenac is available. Developed in Ontario and manufactured in Quebec,
Pennsaid(R) is a relatively new medication approved in Canada to treat pain
and stiffness related to osteoarthritis of the knee.
Pennsaid(R) combines diclofenac sodium, the "gold standard" NSAID, with a
patented carrier solution. When spread on the skin, Pennsaid(R) delivers
active drug directly to the pain site. |
