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1.
Brasília; CONITEC; out. 2020.
No convencional en Portugués | BRISA/RedTESA | ID: biblio-1141599

RESUMEN

INTRODUÇÃO: A artrite reativa (ARe) pertence ao grupo das espondiloartrites e é convencionalmente definida como uma artrite que surge após uma infecção extra-articular, geralmente geniturinária ou gastrointestinal. É uma doença relativamente rara que acomete tipicamente adultos jovens. O tratamento da ARe possui diferentes abordagens, e inclui o tratamento da infecção desencadeante e das manifestações musculoesqueléticas. O uso de anti-inflamatórios não esteroidais (AINE) constitui a abordagem inicial do tratamento da doença articular sintomática. De acordo com o Protocolo Clínico e Diretrizes Terapêuticas (PCDT) da Artrite Reativa de 2015, o único AINE disponibilizado para a doença no Sistema Único de Saúde (SUS) é o ibuprofeno. O naproxeno é um AINE não seletivo que possui tradição de uso e histórico de incorporações no SUS para condições musculoesqueléticas (espondilite anquilosante, artrite psoriásica, artrite reumatoide, osteoartrite de joelho e quadril), além de representar uma alternativa mais segura em relação aos eventos cardiovasculares quando comparado a outros AINE. PERGUNTA: O naproxeno é uma opção segura e eficaz para o tratamento da ARe? EVIDÊNCIAS CIENTÍFICAS: Foram realizadas buscas nas bases de dados Medline (via Pubmed) e Embase. Uma revisão sistemática (RS) de avaliação de AINE em espondiloartrites foi elegível. A RS incluiu cinco ensaios clínicos randomizados (ECR) de avaliação do naproxeno, sendo três em comparação a outros AINE (aceclofenaco, butacote, piroxicam) e dois em comparação a outros AINE (celecoxibe, etoricoxibe) e placebo. Os estudos que incluíram a comparação com placebo avaliaram desfechos de eficácia e segurança em pacientes com espondilite anquilosante. Os estudos evidenciaram benefício do naproxeno na melhora da dor, avaliação global do paciente, escore BASDAI e escore BASFI, sem aumento significativo dos eventos adversos, com exceção de um estudo que evidenciou maior taxa de eventos adversos (EA) gastrointestinais. AVALIAÇÃO DE IMPACTO ORÇAMENTÁRIO: a estimativa de custo global anual no cenário base foi de aproximadamente 27 mil reais, com impacto cumulativo em 5 anos de cerca de 138 mil reais. Na análise de sensibilidade, foram observados valores de 42 mil reais no cenário mais otimista, e acima de 516 mil reais no cenário mais pessimista, para o período de 5 anos. A variável de maior impacto nos resultados foi o custo unitário do medicamento. Análise comparativa com ibuprofeno evidencia custo incremental entre R$ 16,38 a R$ 28,35 por paciente tratado com naproxeno. CONSIDERAÇÕES: Não foram identificados estudos de avaliação do naproxeno em ARe e nenhum estudo comparou naproxeno com ibuprofeno, AINE já disponibilizado no SUS. A evidência disponível avalia a eficácia e a segurança do naproxeno em comparação a placebo, em pacientes com espondilite anquilosante, espondiloartrite que acomete preferencialmente a coluna vertebral. Os estudos evidenciam benefício do medicamento, sem comprometimento significativo da segurança. Apesar da escassez de evidências do uso de naproxeno em ARe, seu uso baseia-se na experiência clínica e na evidência de benefício em outras condições musculoesqueléticas, particularmente em outras formas de espondiloatrite. O medicamento possui tradição de uso e histórico de incorporações no SUS para condições semelhantes. RECOMENDAÇÃO PRELIMINAR: Diante do exposto, a Conitec, em sua 88ª reunião ordinária, realizada no dia 08 de julho de 2020, deliberou que a matéria fosse disponibilizada em consulta pública com recomendação preliminar favorável à incorporação do naproxeno como opção terapêutica da ARe no Sistema Único de Saúde. CONSULTA PÚBLICA: A Consulta Pública nº 43/2020 foi realizada entre os dias 20/08/2020 a 08/09/2020. Foram recebidas 89 contribuições no total, das quais 5 (5,6%) foram pelo formulário para contribuições técnico-científicas e 84 (94,4%) pelo formulário para contribuições sobre experiência ou opinião de pacientes, familiares, amigos ou cuidadores de pacientes, profissionais de saúde ou pessoas interessadas no tema. Das 5 contribuições de cunho técnico-científico, uma era relacionada a outro tema de consulta pública, sendo consideradas na análise somente quatro contribuições. Em relação à recomendação preliminar da Conitec, que foi favorável à ampliação do uso do naproxeno, dois participantes submeteram a contribuição com opinião favorável a recomendação preliminar da comissão. As outras duas contribuições discordaram da recomendação preliminar da Conitec. Foram recebidas 84 contribuições de experiência e opinião, no entanto 37 contribuições possuíam comentários relacionadas a outro tema de consulta pública, não sendo consideradas na análise. Em relação à recomendação preliminar da Conitec, 18 participantes (38%) submeteram a contribuição com opinião favorável a recomendação preliminar da comissão, uma contribuição não concordou e não discordou da recomendação e 28 participantes (59%) discordaram da recomendação preliminar da Conitec. Houve onze relatos sobre a recomendação preliminar, no entanto, nove deles relatavam discordância com relação a não incorporação de uma tecnologia, não sendo o caso da tecnologia avaliada neste relatório. RECOMENDAÇÃO FINAL: Os membros do Plenário presentes na 91ª Reunião Ordinária da Conitec, no dia 07 de outubro de 2020, deliberaram, por unanimidade, recomendar a ampliação de uso do naproxeno para o tratamento de pacientes com Artrite Reativa. Na apreciação da CP, os membros do Plenário entenderam que a maioria das contribuições relatavam discordância em relação a não incorporação de uma tecnologia, não sendo o caso da tecnologia avaliada neste relatório, sendo assim mantiveram a recomendação preliminar. Foi assinado o Registro de Deliberação nº 558/2020. DECISÃO: Ampliar o uso do naproxeno para o tratamento de pacientes com artrite reativa, no âmbito do Sistema Único de Saúde - SUS, conforme Portaria n° 48, publicada no Diário Oficial da União n° 217, seção 1, página 144, em 13 de novembro de 2020.


Asunto(s)
Humanos , Naproxeno/uso terapéutico , Artritis Reactiva/tratamiento farmacológico , Evaluación de la Tecnología Biomédica , Sistema Único de Salud , Brasil , Análisis Costo-Beneficio/economía
2.
Curr Sports Med Rep ; 19(6): 199-201, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32516189

RESUMEN

Pyogenic flexor tenosynovitis (PFT) is an orthopedic emergency that necessitates prompt diagnosis and treatment. Unfortunately, the diagnosis is largely clinically based on Kanavel's four cardinal signs with all four symptoms being present approximately 22% to 56% of the time. Evidence suggests that PFT diagnosed within 48 h of onset does not need surgical intervention. Ultrasonography can be used to aid in the diagnosis of PFT. It has a sensitivity of 94.4% and a negative predictive value of 96.7%. This illustrative case report demonstrates ultrasound's utility to not only aid in diagnosis but also serve as a tool for monitoring patient response.


Asunto(s)
Mano/diagnóstico por imagen , Tenosinovitis/diagnóstico por imagen , Ultrasonografía , Adulto , Antibacterianos/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Cefalexina/uso terapéutico , Diagnóstico Diferencial , Humanos , Masculino , Personal Militar , Naproxeno/uso terapéutico , Tenosinovitis/tratamiento farmacológico
3.
Brasília; s.n; 25 jun. 2020.
No convencional en Portugués | LILACS, BRISA/RedTESA, PIE | ID: biblio-1102293

RESUMEN

O Informe Diário de Evidências é uma produção do Ministério da Saúde que tem como objetivo acompanhar diariamente as publicações científicas sobre tratamento farmacológico e vacinas para a COVID-19. Dessa forma, são realizadas buscas estruturadas em bases de dados biomédicas, referente ao dia anterior desse informe. Não são incluídos estudos pré-clínicos (in vitro, in vivo, in silico). A frequência dos estudos é demonstrada de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, coortes, entre outros). Para cada estudo é apresentado um resumo com avaliação da qualidade metodológica. Essa avaliação tem por finalidade identificar o grau de certeza/confiança ou o risco de viés de cada estudo. Para tal, são utilizadas ferramentas já validadas e consagradas na literatura científica, na área de saúde baseada em evidências. Cabe ressaltar que o documento tem caráter informativo e não representa uma recomendação oficial do Ministério da Saúde sobre a temática. Foram encontrados 14 artigos e 9 protocolos.


Asunto(s)
Humanos , Neumonía Viral/tratamiento farmacológico , Infecciones por Coronavirus/tratamiento farmacológico , Betacoronavirus/efectos de los fármacos , Evaluación de la Tecnología Biomédica , Inmunoglobulinas/uso terapéutico , Dexametasona/uso terapéutico , Metilprednisolona/uso terapéutico , Prednisolona/uso terapéutico , Naproxeno/uso terapéutico , Azitromicina/uso terapéutico , Ritonavir/uso terapéutico , Proteína Antagonista del Receptor de Interleucina 1/uso terapéutico , Lopinavir/uso terapéutico
4.
Medicine (Baltimore) ; 99(19): e19881, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32384431

RESUMEN

BACKGROUND: Primary dysmenorrhea is common and troublesome. The comparative efficacy of over-the-counter analgesics (OTCAs) for dysmenorrhea is unclear. This study was aimed at conducting a network meta-analysis to assess the efficacy and safety of 5 OTCAs - naproxen, ibuprofen,diclofenac, aspirin, and ketoprofen - in patients with primary dysmenorrhea. METHODS: The study was registered with PROSPERO (number: CRD42019133556). The search strategy involved a review of PubMed, Embase, Cochrane Library, Web of Science, and CINAHL for relative randomized controlled trials of the 5 analgesics from the date of database establishment to July 2019. The outputs are presented as odds ratios (ORs), their corresponding 95% confidence intervals (CIs), and the surface under the cumulative ranking area (SUCRA) probabilities. RESULTS: Thirty-five trials with 4383 participants were included in our study. As for efficacy outcomes, all the included analgesics except aspirin were more effective than placebo in treating dysmenorrhea [naproxen (OR 3.99, 95% CI 2.18-7.30), ibuprofen (OR 10.08, 95% CI 3.29-30.85), diclofenac (OR 11.82, 95% CI 2.66-52.48), and ketoprofen (OR 5.12, 95% CI 1.57-16.69). The OTCAs were superior to the placebo in terms of pain relief in primary dysmenorrhea. Aspirin was less effective than ibuprofen (OR 0.17, 95% CI 0.04-0.73) and diclofenac (OR 1.17, 95% CI 0.02-0.85). The SUCRA curves showed that diclofenac and ibuprofen were the most and second most effective (85.1% and 83.8%, respectively), followed by ketoprofen, naproxen, and aspirin. Regarding safety, there was no significant difference between the 5 OTCAs included and the placebo. Diclofenac versus ibuprofen (OR 4.31, 95% CI 1.18-15.67), ketoprofen versus diclofenac (OR 0.18, 95% CI 0.04-0.78), and ketoprofen versus aspirin (OR 0.41, 95% CI 0.18-0.97) presented statistically significant differences. Ketoprofen and ibuprofen were ranked the best (SUCRA 90.6% and 79.6%), followed by naproxen, aspirin, and diclofenac. CONCLUSION: Considering the efficacy and safety, ibuprofen is recommended as the optimal OTCA for primary dysmenorrhea. Further well-designed studies that directly compare these analgesics are needed to support our conclusion.


Asunto(s)
Analgésicos/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Dismenorrea/tratamiento farmacológico , Medicamentos sin Prescripción/uso terapéutico , Adolescente , Adulto , Aspirina/uso terapéutico , Diclofenaco/uso terapéutico , Femenino , Humanos , Ibuprofeno/uso terapéutico , Cetoprofeno/uso terapéutico , Persona de Mediana Edad , Naproxeno/uso terapéutico , Metaanálisis en Red , Resultado del Tratamiento , Adulto Joven
5.
Cochrane Database Syst Rev ; 4: CD011459, 2020 04 30.
Artículo en Inglés | MEDLINE | ID: mdl-32352165

RESUMEN

BACKGROUND: Dementia is a worldwide concern. Its global prevalence is increasing. At present, there is no medication licensed to prevent or delay the onset of dementia. Inflammation has been suggested as a key factor in dementia pathogenesis. Therefore, medications with anti-inflammatory properties could be beneficial for dementia prevention. OBJECTIVES: To evaluate the effectiveness and adverse effects of aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) for the primary or secondary prevention of dementia. SEARCH METHODS: We searched ALOIS, the specialised register of the Cochrane Dementia and Cognitive Improvement Group up to 9 January 2020. ALOIS contains records of clinical trials identified from monthly searches of several major healthcare databases, trial registries and grey literature sources. We ran additional searches across MEDLINE (OvidSP), Embase (OvidSP) and six other databases to ensure that the searches were as comprehensive and up-to-date as possible. We also reviewed citations of reference lists of included studies. SELECTION CRITERIA: We searched for randomised controlled trials (RCTs) and controlled clinical trials (CCTs) comparing aspirin or other NSAIDs with placebo for the primary or secondary prevention of dementia. We included trials with cognitively healthy participants (primary prevention) or participants with mild cognitive impairment (MCI) or cognitive complaints (secondary prevention). DATA COLLECTION AND ANALYSIS: We used standard methodological procedures according to the Cochrane Handbook for Systematic Reviews of Interventions. We rated the strength of evidence for each outcome using the GRADE approach. MAIN RESULTS: We included four RCTs with 23,187 participants. Because of the diversity of these trials, we did not combine data to give summary estimates, but presented a narrative description of the evidence. We identified one trial (19,114 participants) comparing low-dose aspirin (100 mg once daily) to placebo. Participants were aged 70 years or older with no history of dementia, cardiovascular disease or physical disability. Interim analysis indicated no significant treatment effect and the trial was terminated slightly early after a median of 4.7 years' follow-up. There was no evidence of a difference in incidence of dementia between aspirin and placebo groups (risk ratio (RR) 0.98, 95% CI 0.83 to 1.15; high-certainty evidence). Participants allocated aspirin had higher rates of major bleeding (RR 1.37, 95% CI 1.17 to 1.60, high-certainty evidence) and slightly higher mortality (RR 1.14, 95% CI 1.01 to 1.28; high-certainty evidence). There was no evidence of a difference in activities of daily living between groups (RR 0.84, 95% CI 0.70 to 1.02; high-certainty evidence). We identified three trials comparing non-aspirin NSAIDs to placebo. All three trials were terminated early due to adverse events associated with NSAIDs reported in other trials. One trial (2528 participants) investigated the cyclo-oxygenase-2 (COX-2) inhibitor celecoxib (200 mg twice daily) and the non-selective NSAID naproxen (220 mg twice daily) for preventing dementia in cognitively healthy older adults with a family history of Alzheimer's disease (AD). Median follow-up was 734 days. Combining both NSAID treatment arms, there was no evidence of a difference in the incidence of AD between participants allocated NSAIDs and those allocated placebo (RR 1.91, 95% CI 0.89 to 4.10; moderate-certainty evidence). There was also no evidence of a difference in rates of myocardial infarction (RR 1.21, 95% CI 0.61 to 2.40), stroke (RR 1.82, 95% CI 0.76 to 4.37) or mortality (RR 1.37, 95% CI 0.78 to 2.43) between treatment groups (all moderate-certainty evidence). One trial (88 participants) assessed the effectiveness of celecoxib (200 mg or 400 mg daily) in delaying cognitive decline in participants aged 40 to 81 years with mild age-related memory loss but normal memory performance scores. Mean duration of follow-up was 17.6 months in the celecoxib group and 18.1 months in the placebo group. There was no evidence of a difference between groups in test scores in any of six cognitive domains. Participants allocated celecoxib experienced more gastrointestinal adverse events than those allocated placebo (RR 2.66, 95% CI 1.05 to 6.75; low-certainty evidence). One trial (1457 participants) assessed the effectiveness of the COX-2 inhibitor rofecoxib (25 mg once daily) in delaying or preventing a diagnosis of AD in participants with MCI. Median duration of study participation was 115 weeks in the rofecoxib group and 130 weeks in the placebo group. There was a higher incidence of AD in the rofecoxib than the placebo group (RR 1.32, 95% CI 1.01 to 1.72; moderate-certainty evidence). There was no evidence of a difference between groups in cardiovascular adverse events (RR 1.07, 95% CI 0.68 to 1.66; moderate-certainty evidence) or mortality (RR 1.62, 95% CI 0.85 to 3.05; moderate-certainty evidence). Participants allocated rofecoxib had more upper gastrointestinal adverse events (RR 3.53, 95% CI 1.17 to 10.68; moderate-certainty evidence). Reported annual mean difference scores showed no evidence of a difference between groups in activities of daily living (year 1: no data available; year 2: 0.0, 95% CI -0.1 to 0.2; year 3: 0.1, 95% CI -0.1 to 0.3; year 4: 0.1, 95% CI -0.1 to 0.4; moderate-certainty evidence). AUTHORS' CONCLUSIONS: There is no evidence to support the use of low-dose aspirin or other NSAIDs of any class (celecoxib, rofecoxib or naproxen) for the prevention of dementia, but there was evidence of harm. Although there were limitations in the available evidence, it seems unlikely that there is any need for further trials of low-dose aspirin for dementia prevention. If future studies of NSAIDs for dementia prevention are planned, they will need to be cognisant of the safety concerns arising from the existing studies.


Asunto(s)
Antiinflamatorios no Esteroideos/uso terapéutico , Aspirina/uso terapéutico , Demencia/prevención & control , Actividades Cotidianas , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/epidemiología , Enfermedad de Alzheimer/prevención & control , Antiinflamatorios no Esteroideos/administración & dosificación , Antiinflamatorios no Esteroideos/efectos adversos , Aspirina/administración & dosificación , Aspirina/efectos adversos , Celecoxib/administración & dosificación , Celecoxib/efectos adversos , Celecoxib/uso terapéutico , Inhibidores de la Ciclooxigenasa 2/administración & dosificación , Inhibidores de la Ciclooxigenasa 2/efectos adversos , Inhibidores de la Ciclooxigenasa 2/uso terapéutico , Demencia/epidemiología , Demencia/mortalidad , Hemorragia/inducido químicamente , Hemorragia/epidemiología , Humanos , Incidencia , Lactonas/uso terapéutico , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Naproxeno/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto , Accidente Cerebrovascular/epidemiología , Sulfonas/uso terapéutico
6.
JAAPA ; 33(5): 28-30, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32345945

RESUMEN

Evaluating patients for abdominal pain is common in the ED and can involve many differential diagnoses and treatment options. This case report describes a 35-year-old active duty military man whose abdominal pain evaluation at a military treatment facility led to the diagnosis of epiploic appendagitis.


Asunto(s)
Abdomen Agudo/etiología , Colitis/complicaciones , Tratamiento Conservador/métodos , Manejo del Dolor/métodos , Enfermedades del Sigmoide/complicaciones , Abdomen Agudo/diagnóstico por imagen , Abdomen Agudo/tratamiento farmacológico , Acetaminofén/uso terapéutico , Adulto , Colitis/diagnóstico , Colitis/tratamiento farmacológico , Humanos , Hidromorfona/uso terapéutico , Ketorolaco/uso terapéutico , Masculino , Naproxeno/uso terapéutico , Enfermedades del Sigmoide/diagnóstico por imagen , Enfermedades del Sigmoide/tratamiento farmacológico , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
7.
Phytother Res ; 34(8): 2067-2073, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32180294

RESUMEN

Osteoarthritis is the most common articular disease that can lead to chronic pain and severe disability. Curcumin-an effective ingredient in turmeric with anti inflammatory property-plays an important role in protecting the joints against destructive factors. Gingerols and piperine, are the effective ingredients of ginger and black pepper, which may potentially enhance and sustain the effect of curcumin in this direction. To determine the effect of cosupplementation with turmeric extract, black pepper, and ginger on prostaglandin E2 (PGE2 ) in patients with chronic knee osteoarthritis, compared with Naproxen. Sixty patients with two different levels of knee osteoarthritis (Grade 2 and 3) were studied. Individuals were randomly assigned to receive daily turmeric extract, ginger, and black pepper together or Naproxen capsule for 4 weeks. PGE2 was evaluated by ELISA method. 24-hr recall was also assessed. All of participants completed the study. PGE2 decreased significantly in both groups (p < .001), but there was no significant differences between groups. The results of this study indicated that intake of the selected herbs twice a day for 4 weeks may improve the PGE2 levels in patients with chronic knee osteoarthritis similar to Naproxen drug.


Asunto(s)
Antiinflamatorios no Esteroideos/uso terapéutico , Curcuma/química , Curcumina/química , Jengibre/química , Naproxeno/uso terapéutico , Osteoartritis de la Rodilla/tratamiento farmacológico , Piper nigrum/química , Extractos Vegetales/química , Antiinflamatorios no Esteroideos/farmacología , Enfermedad Crónica , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Naproxeno/farmacología
8.
PLoS One ; 15(1): e0226184, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31986170

RESUMEN

OBJECTIVE: Selective cyclooxygenase-2 inhibitors (celecoxib) can minimize the gastrointestinal complications related to non-steroidal anti-inflammatory drug (NSAID) use. NAXOZOL is a new combination formulation designed to provide sequential delivery of a non-enteric-coated, immediate-release esomeprazole strontium tetrahydrate 20 mg mantle followed by an enteric-coated naproxen 500 mg core. However, there have been no studies comparing NAXOZOL to celecoxib with respect to gastrointestinal tract protection and pain relief in patients with osteoarthritis. This study was undertaken to compare the effects of NAXOZOL and celecoxib with respect to gastrointestinal tract protection and pain relief in patients with osteoarthritis. METHODS: The randomized enrolled patients were divided into two treatment groups: a NAXOZOL group and a celecoxib group. All participants received treatments (NAXOZOL, 500/20 mg (naproxen 500 mg, esomeprazole strontium tetrahydrate 20 mg) twice per day versus celecoxib, 200 mg daily) on a 1:1 allocation basis for 12 weeks. The primary outcome was the Leeds Dyspepsia Questionnaire (LDQ) score used for non-inferiority testing. Secondary outcome measures included the Gastrointestinal Symptom Rating Scale (GSRS) score, Visual Analogue Scale (VAS) score, European Quality of Life-5 dimensions (EQ-5D) scale and the EQ-5D Visual Analogue Scale (EQ VAS). Other outcome measures included the use of supplementary or rescue drugs, and the incidence of adverse events. RESULTS: The baseline-adjusted LDQ scores immediately after 12 weeks of treatment in NAXOZOL group were not inferior to those in celecoxib group. The overall change in the baseline-adjusted GSRS score, VAS score, EQ-5D, and EQ VAS was not different between the two groups. The usage of supplementary drugs and the drug-related incidence of adverse events were not different. However, the days to use rescue drug were longer in celecoxib group than in NAXOZOL group. CONCLUSION: NAXOZOL was not inferior to celecoxib in protecting the gastrointestinal tract and providing pain relief in patients with osteoarthritis.


Asunto(s)
Antiinflamatorios no Esteroideos/uso terapéutico , Celecoxib/uso terapéutico , Esomeprazol/uso terapéutico , Enfermedades Gastrointestinales/prevención & control , Naproxeno/uso terapéutico , Osteoartritis/tratamiento farmacológico , Dolor/prevención & control , Anciano , Antiulcerosos/uso terapéutico , Método Doble Ciego , Femenino , Humanos , Masculino , Estudios Prospectivos , Encuestas y Cuestionarios
10.
Arthritis Res Ther ; 21(1): 224, 2019 11 06.
Artículo en Inglés | MEDLINE | ID: mdl-31694709

RESUMEN

BACKGROUND: Identification of the optimal treatment for a given patient is of paramount importance. This is of particular relevance in osteoarthritis (OA) because of the high prevalence of the disease, extensive heterogeneity of the disease, and need for long-term treatment. The aim of the study was to examine whether serum lysophosphatidylcholines (lysoPCs) to phosphatidylcholines (PCs) ratio can predict clinical response to licofelone and naproxen treatments in symptomatic knee OA patients. METHODS: One hundred fifty-eight OA patients who completed the study according to protocol (ATP) of a previous 24-month clinical trial cohort comparing the effect of licofelone vs. naproxen in symptomatic knee OA patients were included. Symptomatic responses to either treatments were classified according to the OARSI-OMERACT criteria based on the WOMAC scores at 24 months. Total concentrations of PCs and lysoPCs were measured in the serum samples collected before the initiation of the treatments, and the lysoPCs to PCs ratio was calculated. Student's t test was utilized to compare the difference in the ratio of lysoPCs to PCs between the symptomatic responders and non-responders. Logistic regression was utilized to adjust for the potential confounders. Receiver operating characteristic (ROC) analysis was performed to identify the optimal cutoff of the ratio for prediction. RESULTS: Data showed that 61.4% of the patients symptomatically responded to licofelone and naproxen and 38.6% were deemed as therapeutic failures (non-responders). There was no difference in responders between licofelone and naproxen (p = 0.87). Responders had a significantly higher lysoPCs to PCs ratio than non-responders (0.097 ± 0.003 vs. 0.085 ± 0.003; p = 0.006). Patients with a ratio greater than the optimal cutoff of 0.088 had 2.93 times more likely to respond to licofelone and naproxen (p = 0.002). CONCLUSIONS: Serum lysoPCs to PCs ratio is a marker for response to licofelone and naproxen and may aid in the personalized treatment to knee OA.


Asunto(s)
Lisofosfatidilcolinas/sangre , Naproxeno/uso terapéutico , Osteoartritis de la Rodilla/sangre , Osteoartritis de la Rodilla/tratamiento farmacológico , Fosfatidilcolinas/sangre , Pirroles/uso terapéutico , Anciano , Antiinflamatorios no Esteroideos/uso terapéutico , Biomarcadores/sangre , Inhibidores de la Ciclooxigenasa/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento
11.
Pak J Pharm Sci ; 32(3 Special): 1415-1418, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-31551223

RESUMEN

To evaluate the clinical efficacy of combined therapy of Zushima tablet and western medicine in treatment of rheumatoid arthritis and analyze the MRI test results. A total of 170 patients who had been treated for rheumatoid arthritis at our hospital from August 2016 and June 2018, were enrolled as research objects. They were randomly divided into control group and research group, with 85 patients in each group. The patients in the control group were treated with western medicine, while patients in the research group were treated with combined therapy of Zushima tablet and western medicine. The clinical efficacies of two groups were compared. results showed that the overall effective rate of the research group was higher than that of the control group (p<0.05). Various clinical symptoms including joint swelling, joint tenderness, duration of morning stiffness for both groups before and after treatment were recorded, and results showed that the improvement of the research group was significantly better than that of the control group (p<0.05). Application of combined therapy of Zushima tablet and western medicine in treatment of rheumatoid arthritis could lead to favorable effects and improvement of the patients' clinical symptoms.


Asunto(s)
Antirreumáticos/uso terapéutico , Artritis Reumatoide/tratamiento farmacológico , Medicamentos Herbarios Chinos/uso terapéutico , Adulto , Artritis Reumatoide/diagnóstico por imagen , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Metotrexato/uso terapéutico , Persona de Mediana Edad , Naproxeno/uso terapéutico , Prednisolona/uso terapéutico , Sulfasalazina/uso terapéutico , Comprimidos , Resultado del Tratamiento , Mundo Occidental
12.
Cochrane Database Syst Rev ; 9: CD000400, 2019 09 19.
Artículo en Inglés | MEDLINE | ID: mdl-31535715

RESUMEN

BACKGROUND: Heavy menstrual bleeding (HMB) is an important cause of ill health in premenopausal women. Although surgery is often used as a treatment, a range of medical therapies are also available. Non-steroidal anti-inflammatory drugs (NSAIDs) reduce prostaglandin levels, which are elevated in women with excessive menstrual bleeding and also may have a beneficial effect on dysmenorrhoea. OBJECTIVES: To determine the effectiveness, safety and tolerability of NSAIDs in achieving a reduction in menstrual blood loss (MBL) in women of reproductive years with HMB. SEARCH METHODS: We searched, in April 2019, the Cochrane Gynaecology and Fertility specialised register, Cochrane Central Register of Studies Online (CENTRAL CRSO), MEDLINE, Embase, PsycINFO, the clinical trial registries and reference lists of articles. SELECTION CRITERIA: The inclusion criteria were randomised comparisons of individual NSAIDs or combined with other medical therapy with each other, placebo or other medical treatments in women with regular heavy periods measured either objectively or subjectively and with no pathological or iatrogenic (treatment-induced) causes for their HMB. DATA COLLECTION AND ANALYSIS: We identified 19 randomised controlled trials (RCTs) (759 women) that fulfilled the inclusion criteria for this review and two review authors independently extracted data. We estimated odds ratios (ORs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes from the data of nine trials. We described in data tables the results of the remaining seven cross-over trials with data unsuitable for pooling, one trial with skewed data, and one trial with missing variances. One trial had no data available for analysis. MAIN RESULTS: As a group, NSAIDs were more effective than placebo at reducing HMB but less effective than tranexamic acid, danazol or the levonorgestrel-releasing intrauterine system (LNG IUS). Treatment with danazol caused a shorter duration of menstruation and more adverse events than NSAIDs, but this did not appear to affect the acceptability of treatment, based on trials from 1980 to 1990. However, currently danazol is not a usual or recommended treatment for HMB. There was no clear evidence of difference between NSAIDs and the other treatments (oral luteal progestogen, ethamsylate, an older progesterone-releasing intrauterine system and the oral contraceptive pill (OCP), but most studies were underpowered. There was no evidence of a difference between the individual NSAIDs (naproxen and mefenamic acid) in reducing HMB. The evidence quality ranged from low to moderate, the main limitations being risk of bias and imprecision. AUTHORS' CONCLUSIONS: NSAIDs reduce HMB when compared with placebo, but are less effective than tranexamic acid, danazol or LNG IUS. However, adverse events are more severe with danazol therapy. In the limited number of small studies suitable for evaluation, there was no clear evidence of a difference in efficacy between NSAIDs and other medical treatments such as oral luteal progestogen, ethamsylate, OCP or the older progesterone-releasing intrauterine system.


Asunto(s)
Antiinflamatorios no Esteroideos/uso terapéutico , Dismenorrea/tratamiento farmacológico , Menorragia/tratamiento farmacológico , Anticonceptivos Orales Combinados , Femenino , Humanos , Naproxeno/uso terapéutico , Progesterona/administración & dosificación , Ensayos Clínicos Controlados Aleatorios como Asunto
13.
Osteoarthritis Cartilage ; 27(11): 1590-1598, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31356878

RESUMEN

OBJECTIVE: To investigate the TrkA inhibitor, ASP7962, for treatment of painful knee osteoarthritis. DESIGN: Phase 2a, double-blind, placebo- and naproxen-controlled, double-dummy, parallel-group study. Adults with knee osteoarthritis were randomized (2:2:1) to ASP7962 (100 mg), placebo, or naproxen (500 mg) twice daily (BID) for 4 weeks. Primary endpoint: change from baseline to Week 4 in Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain subscale score. Secondary endpoints: change from baseline to Weeks 1, 2, and End of Treatment (EoT) in WOMAC pain subscale score; change from baseline to Weeks 1, 2, 4, and EoT in WOMAC physical function and stiffness subscales, walking pain and WOMAC total scores; and change from baseline in daily average pain score. RESULTS: 215 participants were randomized (ASP7962 100 mg BID, n = 85; placebo, n = 87; naproxen 500 mg BID, n = 43). No significant difference was observed between ASP7962 and placebo in change from baseline to Week 4 in WOMAC pain subscale score (-0.14; 90% 2-sided CI: -0.62, 0.34; P = 0.316); a significant difference was observed between naproxen and placebo (-0.67; 80% 2-sided CI: -1.12, -0.23; P = 0.027). No differences were observed between ASP7962 and placebo in change from baseline in any WOMAC subscale score; statistically significant changes were observed between naproxen and placebo (P ≤ 0.01, all time points for all WOMAC endpoints). ASP7962 was safe and well-tolerated. CONCLUSIONS: Four-week treatment with ASP7962 (100 mg BID) did not improve pain or physical function in individuals with painful knee osteoarthritis. ClinicalTrials.gov, NCT02611466; EudraCT Number, 2014-004996-22.


Asunto(s)
Artralgia/tratamiento farmacológico , Naproxeno/uso terapéutico , Receptor trkA/antagonistas & inhibidores , Adolescente , Adulto , Anciano , Antiinflamatorios no Esteroideos/uso terapéutico , Artralgia/diagnóstico , Artralgia/etiología , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/complicaciones , Dimensión del Dolor/métodos , Resultado del Tratamiento , Adulto Joven
14.
Gastroenterol Hepatol ; 42(10): 622-623, 2019 Dec.
Artículo en Inglés, Español | MEDLINE | ID: mdl-31324464
15.
Artículo en Ruso | MEDLINE | ID: mdl-31317886

RESUMEN

AIM: To assess the efficacy and safety of naproxen in patients with nonspecific low back pain. MATERIAL AND METHODS: Ninety patients with nonspecific low back pain were enrolled in the study. Patients took 550 mg of naproxen twice a day. All patients were assessed with VAS, the Oswestry questionnaire, Schober's test and clinical global impression scale. The treatment lasted from 7 to 14 days depending on the pain relief (VAS ≤10 mm). RESULTS: The pain syndrome relief was observed in 77 patients (88.5%) during the first week of the treatment and in 81 (93.1%) by the end of the study. The average value of VAS was reduced by 6.2 times (by 52.9 mm) in comparison to the baseline. According to the Oswestry questionnaire the influence of pain syndrome on the life quality was reduced by 4,78 times in comparison to the baseline. Schober's test revealed an increase in the amplitude of movements during therapy by 27% in comparison to the baseline. Only 5 (5.7%) drug-related adverse reactions were observed during the whole study, 80% of those were mild. CONCLUSION: Naproxen in the dose of 550 mg twice a day demonstrates the high efficacy and safety in patients with non-specific pain in lumbosacral spine.


Asunto(s)
Antiinflamatorios no Esteroideos , Dolor de la Región Lumbar , Naproxeno , Antiinflamatorios no Esteroideos/efectos adversos , Antiinflamatorios no Esteroideos/uso terapéutico , Método Doble Ciego , Humanos , Dolor de la Región Lumbar/tratamiento farmacológico , Región Lumbosacra , Naproxeno/efectos adversos , Naproxeno/uso terapéutico , Resultado del Tratamiento
16.
Ann Clin Transl Neurol ; 6(6): 1127-1133, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31211178

RESUMEN

We studied 78 participants having a parental or multiple-sibling history of Alzheimer's disease (AD) in a two-year randomized placebo-controlled trial of naproxen 220 mg b.i.d. for mitigation of early AD pathogenesis. Naproxen was detected in cerebrospinal fluid at concentrations ~100 times lower than in plasma, but produced negligible change in immune markers. The repeated lack of benefit in AD prevention trials using naproxen and related drugs may reflect limited CNS permeability, lack of expected drug effects, or both. These findings suggest reconsideration of implications from results of AD prevention trials using anti-inflammatory drugs.


Asunto(s)
Biomarcadores/líquido cefalorraquídeo , Naproxeno/líquido cefalorraquídeo , Naproxeno/uso terapéutico , Enfermedad de Alzheimer/líquido cefalorraquídeo , Enfermedad de Alzheimer/tratamiento farmacológico , Antiinflamatorios no Esteroideos/uso terapéutico , Celecoxib/uso terapéutico , Citocinas/líquido cefalorraquídeo , Femenino , Humanos , Interferón alfa-2/líquido cefalorraquídeo , Proteína Antagonista del Receptor de Interleucina 1/líquido cefalorraquídeo , Masculino , Persona de Mediana Edad
17.
Medicine (Baltimore) ; 98(22): e15840, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-31145329

RESUMEN

BACKGROUND: The effect of naproxen on the treatment of neoplastic fever is still unclear. A systematic review and meta-analysis were performed to investigate the effect of naproxen in the treatment of cancer fever or suspicion. Besides, the latest and most convincing evidence was provided for the earlier use of naproxen in treating cancer patients with fever of unknown origin. METHODS: A literature review was conducted to identify all published studies on the naproxen for the treatment of neoplastic fever. Electronic databases (eg, PUBMED, EMBASE and the Cochrane Library) were searched until October 2018. Data were extracted, and the risk of bias was assessed by 2 authors independently. Standard meta-analyses on the rate of successful treatment were conducted using a random-effects model, and relative risks were calculated with 95% confidence intervals (CIs). RESULTS: A total of 15 studies, recruiting 582 participants, were included, which were 1 randomized controlled trial (RCT), 1 non-RCT, 3 cross-sectional studies, and 10 case-series studies. The result of our meta-analysis revealed that the success rate on the treatment of neoplastic fever using naproxen was 94.1% (95% CI: 87.6%-97.3%). The success rate of the suspected neoplastic fever was 79.8%; for fever of unknown origin, it also reached 67.7%. In this meta-analysis, the success rate was 98.1% (95% CI: 95.0%-99.3%) in the dosage of 250 mg twice a day. Besides, a small dose of 125 mg naproxen, 375 mg twice a day and 250 mg 3 times a day were also useful. The result of the subgroup analysis revealed that the difference was not statistically significant in the treatment success rate for solid tumors and hematologic malignant. CONCLUSIONS: The result of our meta-analysis suggested that naproxen exhibited a highly successful rate for the treatment of neoplastic fever. Besides, naproxen was also satisfactory in improving symptoms of suspected neoplastic fever and fever of unknown origin. The earlier use of naproxen might be able to mitigate cancer patient's suffering and enhanced their quality of life. These findings, however, rely primarily on observational data and should be interpreted rigorously. Further well-conducted trials are required to assess naproxen for the treatment of neoplastic fever.


Asunto(s)
Antiinflamatorios no Esteroideos/uso terapéutico , Fiebre/tratamiento farmacológico , Fiebre/etiología , Naproxeno/uso terapéutico , Neoplasias/complicaciones , Antiinflamatorios no Esteroideos/administración & dosificación , Antiinflamatorios no Esteroideos/efectos adversos , Estudios Transversales , Relación Dosis-Respuesta a Droga , Humanos , Naproxeno/administración & dosificación , Naproxeno/efectos adversos , Calidad de Vida
18.
Breast J ; 25(4): 672-677, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-31087459

RESUMEN

The goal of this study is to compare the response rate and the recurrence rate of available therapeutic modalities in the treatment of Idiopathic Granulomatous Mastitis (IGM). 374 patients with pathologically confirmed IGM, were included. They were subdivided into three levels of severity. Close observation had the best response rate with the lowest recurrence rate in mild to moderate cases. Severe cases were mostly treated by prednisolone or underwent surgery. The outcome of prednisolone use in severe cases was comparable to NSAIDs. Overall 9% were resistant to treatment and surgical intervention is still an option among them.


Asunto(s)
Mastitis Granulomatosa/tratamiento farmacológico , Mastitis Granulomatosa/patología , Adulto , Antiinflamatorios no Esteroideos/uso terapéutico , Biopsia , Lactancia Materna , Femenino , Mastitis Granulomatosa/diagnóstico , Mastitis Granulomatosa/cirugía , Humanos , Irán , Lactancia , Mastectomía Segmentaria , Naproxeno/uso terapéutico , Prednisolona/uso terapéutico , Resultado del Tratamiento
20.
Neurology ; 92(18): e2070-e2080, 2019 04 30.
Artículo en Inglés | MEDLINE | ID: mdl-30952794

RESUMEN

OBJECTIVE: To evaluate the safety and efficacy of low-dose naproxen for prevention of progression in presymptomatic Alzheimer disease (AD) among cognitively intact persons at risk. METHODS: Investigation of Naproxen Treatment Effects in Pre-symptomatic Alzheimer's Disease (INTREPAD), a 2-year double-masked pharmaco-prevention trial, enrolled 195 AD family history-positive elderly (mean age 63 years) participants screened carefully to exclude cognitive disorder (NCT-02702817). These were randomized 1:1 to naproxen sodium 220 mg twice daily or placebo. Multimodal imaging, neurosensory, cognitive, and (in ∼50%) CSF biomarker evaluations were performed at baseline, 3, 12, and 24 months. A modified intent-to-treat analysis considered 160 participants who remained on-treatment through their first follow-up examination. The primary outcome was rate of change in a multimodal composite presymptomatic Alzheimer Progression Score (APS). RESULTS: Naproxen-treated individuals showed a clear excess of adverse events. Among treatment groups combined, the APS increased by 0.102 points/year (SE 0.014; p < 10-12), but rate of change showed little difference by treatment assignment (0.019 points/year). The treatment-related rate ratio of 1.16 (95% confidence interval 0.64-1.96) suggested that naproxen does not reduce the rate of APS progression by more than 36%. Secondary analyses revealed no notable treatment effects on individual CSF, cognitive, or neurosensory biomarker indicators of progressive presymptomatic AD. CONCLUSIONS: In cognitively intact individuals at risk, sustained treatment with naproxen sodium 220 mg twice daily increases frequency of adverse health effects but does not reduce apparent progression of presymptomatic AD. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that, for people who are cognitively intact, low-dose naproxen does not significantly reduce progression of a composite indicator of presymptomatic AD.


Asunto(s)
Enfermedad de Alzheimer/prevención & control , Antiinflamatorios no Esteroideos/uso terapéutico , Naproxeno/uso terapéutico , Anciano , Progresión de la Enfermedad , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Síntomas Prodrómicos , Resultado del Tratamiento
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