Comparative Effectiveness and Safety of Analgesics for Osteoarthritis

[Dr.Vad]

Неплохое суммирование эффективности и безопасности всех НПВС, включая коксибы, и некоторые другие вопросы лечения остеоартрита:

Executive Summary from the Comparative Effectiveness and Safety of Analgesics for Osteoarthritis, an Effective Health Care Final Report from the Agency of Healthcare Research and Quality (AHRQ).

Начало здесь: [Ссылки доступны только зарегистрированным пользователям ]

Конкретно выводы: [Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Зарубили FDA еще один коксиб: этори- (Аркоксиа, Мерк) на основании MEDAL, опубликованного в Ланцете, где он показал себя ненамного лучше диклофенака, как со стороны ССЗ (event rates of 1.24 and 1.30 per 100 patient-years), так и ЖКТ: (0.67 vs 0.97 per 100 patient-years; hazard ratio 0.69 [0.57-0.83]), but the rates of complicated upper gastrointestinal events were similar for etoricoxib (0.30) and diclofenac (0.32).

Так что пока первый коксиб - целекоксиб и остается единственно доступным в своем классе.

[zaitsev]

Сообщение от Dr.Vad

Неплохое суммирование эффективности и безопасности всех НПВС, включая коксибы, и некоторые другие вопросы лечения остеоартрита:

Executive Summary from the Comparative Effectiveness and Safety of Analgesics for Osteoarthritis, an Effective Health Care Final Report from the Agency of Healthcare Research and Quality (AHRQ).

Начало здесь: [Ссылки доступны только зарегистрированным пользователям ]

Конкретно выводы: [Ссылки доступны только зарегистрированным пользователям ]

А если Вы эту статью скачали, можете ее отправить на почтовый адрес.
По ссылке платить надо, а так не хочется

[Dr.Vad]

Как платно? Медскейп бесплатен, просто регистрация нужна, вот ссылка непосредственно на документ на оригинальном сайте (125 стр., ПДФ-формат): [Ссылки доступны только зарегистрированным пользователям ]

[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Целекоксиб с омепразолом полностью защищает от рецидивов ЖКК пациентов с высоким риском развития язвенных кровотечений:

Lancet. 2007 May 12;369(9573):1621-6.

Combination of a cyclo-oxygenase-2 inhibitor and a proton-pump inhibitor for prevention of recurrent ulcer bleeding in patients at very high risk: a double-blind, randomised trial.
Chan FK, Wong VW, Suen BY, Wu JC, Ching JY, Hung LC, Hui AJ, Leung VK, Lee VW, Lai LH, Wong GL, Chow DK, To KF, Leung WK, Chiu PW, Lee YT, Lau JY, Chan HL, Ng EK, Sung JJ.
Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.

BACKGROUND: Guidelines on pain management recommend that patients at risk of ulcers receive either a cyclo-oxygenase (COX 2) inhibitor or a non-steroidal anti-inflammatory drug (NSAID) with a proton-pump inhibitor (PPI). These two treatments have similar effectiveness, but they are insufficient for protection of patients at very high risk for ulcer bleeding. We aimed to test the hypothesis that in patients with previous ulcer bleeding induced by non-selective NSAIDs, combined treatment with the COX 2 inhibitor celecoxib and the PPI esomeprazole would be better than celecoxib alone for prevention of recurrent ulcer bleeding. METHODS: 441 consecutively presenting patients who were taking non-selective NSAIDs for arthritis were recruited to our single-centre, prospective, randomised, double-blind trial after admission to hospital with upper-gastrointestinal bleeding. Patients were enrolled after their ulcers had healed and a histological test for Helicobacter pylori was negative. All patients were given 200 mg celecoxib twice daily. 137 patients were randomly assigned to receive 20 mg esomeprazole twice daily (combined-treatment group), and 136 to receive a placebo (control group) for 12 months. The primary endpoint was recurrent ulcer bleeding during treatment or within 1 month of the end of treatment. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00365313. FINDINGS: Combination treatment was more effective than celecoxib alone for prevention of ulcer bleeding in patients at high risk. The 13-month cumulative incidence of the primary endpoint was 0% in the combined-treatment group and 12 (8.9%) in the controls (95% CI difference, 4.1 to 13.7; p=0.0004). The median follow-up was 13 months (range 0.4-13.0). Discontinuation of treatment and the incidence of adverse events were similar in the two treatment groups. INTERPRETATION: Patients at very high risk for recurrent ulcer bleeding who need anti-inflammatory analgesics should receive combination treatment with a COX 2 inhibitor and a PPI. Our findings should encourage guideline committees to review their recommendations for patients at very high risk of recurrent ulcer bleeding.