[NSAID and gastrointestinal risk]

Systemically Acting Diclofenac Sodium Patch for Control of Low Back Pain: A Randomized, Double-Blind, Placebo-Controlled Study in Japan

INTRODUCTION

Nonsteroidal antiinflammatory drugs (NSAIDs) are commonly used for pain disorders such as low back pain and exist in multiple formulations; however, no systemically acting transdermal formulations are available for low back pain. Transdermal formulations can be safely administered even to patients with trouble swallowing or at risk of aspiration, and without regard to the effect of food on drug absorption. Unlike locally acting formulations, systemically acting transdermal formulations need not be applied at the target site, so dosing is simple and the burden is not on one area of the skin. A patch with the systemically acting NSAID diclofenac sodium is approved in Japan for treatment of cancer-related pain, and we hypothesized that it would be useful for controlling low back pain.

METHODS

This randomized, double-blind, placebo-controlled study aimed to evaluate the efficacy and safety of diclofenac sodium patch in Japanese patients with low back pain. Eligible patients were randomized to receive diclofenac sodium patch 75 mg or 150 mg or placebo once daily for 2 weeks. The primary endpoint was pain intensity assessed on a visual analog scale (VAS).

RESULTS

Primary analysis of the primary endpoint showed that both doses of the diclofenac sodium patch (150 mg and 75 mg) were superior to placebo in terms of absolute change from baseline in mean 3-day VAS score after 2 weeks' treatment; the mean difference between the active and placebo treatments in this variable was -5.67 [95% confidence interval (CI) -9.34 to -2.00] mm in the 150 mg group and -5.68 (95% CI -9.34 to -2.01) mm in the 75 mg group. Most adverse events were mild. No serious adverse events occurred.

CONCLUSION

In Japanese patients, diclofenac sodium patch is effective for the relief of low back pain and is well tolerated.

TRIAL REGISTRATION

JPRN number, JPRN-JapicCTI-205134.

Cross-sectional analysis of retrospective case series of hospitalisations for gastropathy caused by non-steroidal anti-inflammatory treatment: risk factors and gastroprotection use

Objectives

To analyse the risk factors of gastropathy caused by using non-steroidal anti-inflammatory drugs (NSAIDs) in detected hospital admissions and to analyse the use of gastroprotective treatment concerning these risk factors.

Methods

A retrospective observational study was carried out in the framework of an integral risk management plan of drugs and proactive pharmacovigilance of hospital admissions for NSAID-induced gastropathy occurring between 2011 and 2015. Cases were identified after reviewing the ICD-9 codes related to NSAID-induced gastropathy in hospital discharge reports. Various biometric, clinical and pharmacotherapeutic variables of each patient were registered. The gastroprotective criteria set out in the therapeutic decision algorithm of the Valencian Health System were followed.

Results

62 hospital admissions for NSAID-induced gastropathy were detected. The mean length of stay was 5.3±3.8 days. Ibuprofen was the most prevalent NSAID (28 cases, 45.2%). 24 cases (38.7%) took NSAIDs in the week before hospitalisation. The prevalence of relevant risk factors for gastropathy were age >60 years (37 cases, 59.7%), concomitant medication (24 cases, 38.7%) and a history of peptic ulcer (9 cases, 14.5%). 41 patients (66.1%) met gastroprotective major criteria, 18 of whom (43.9%) were using a proton pump inhibitor following a prevention plan.

Conclusions

In this study all relevant gastroprotective criteria were associated with the use of gastroprotection in detected hospital admissions for NSAID-induced gastropathy. However, a lack of gastroprotection was observed in a large number of detected cases with the criteria to use it. The feedback of our results to health area agents can serve to reinforce the safe use of NSAIDs.