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Open Access 01-04-2019 | Osteoarthrosis | Systematic Review

Safety of Topical Non-steroidal Anti-Inflammatory Drugs in Osteoarthritis: Outcomes of a Systematic Review and Meta-Analysis

Authors: Germain Honvo, Victoria Leclercq, Anton Geerinck, Thierry Thomas, Nicola Veronese, Alexia Charles, Véronique Rabenda, Charlotte Beaudart, Cyrus Cooper, Jean-Yves Reginster, Olivier Bruyère

Published in: Drugs & Aging | Special Issue 1/2019

Abstract

Objective

We aimed to assess the safety of topical non-steroidal anti-inflammatory drugs (NSAIDs) in the management of osteoarthritis (OA) in a systematic review and meta-analysis of randomized, placebo-controlled trials.

Methods

A comprehensive literature search was undertaken in the MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus electronic databases. Randomized, double-blind, placebo-controlled, parallel-group trials that assessed adverse events (AEs) with topical NSAIDs in patients with OA were eligible for inclusion. Authors and/or study sponsors were contacted to obtain the full report of AEs. The primary outcomes were overall severe and serious AEs, as well as the following MedDRA System Organ Class (SOC)-related AEs: gastrointestinal, vascular, cardiac, nervous system, skin and subcutaneous tissue, musculoskeletal and connective tissue.

Results

The search strategy identified 1209 records, from which 25 papers were included in the qualitative synthesis and 19 were included in the meta-analysis, after exclusions. Overall, more total AEs (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.04–1.29; I² = 0.0%) and more withdrawals due to AEs (OR 1.49, 95% CI 1.15–1.92; I² = 0.0%) were observed with topical NSAIDs compared with placebo. The same results were achieved with topical diclofenac, largely driven by an increase in skin and subcutaneous tissue disorders (OR 1.73, 95% CI 0.96–3.10), although the difference was not statistically significant compared with placebo. No significant difference in the odds for gastrointestinal disorders was observed between topical NSAIDs and placebo (OR 0.96, 95% CI 0.73–1.27).

Conclusions

Topical NSAIDs may be considered safe in the management of OA, especially with regard to low gastrointestinal toxicity. The use of topical NSAIDs in OA should be considered, taking into account their risk: benefit profile in comparison with other anti-OA treatments.

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Title: Safety of Topical Non-steroidal Anti-Inflammatory Drugs in Osteoarthritis: Outcomes of a Systematic Review and Meta-Analysis
Authors: Germain Honvo
Victoria Leclercq
Anton Geerinck
Thierry Thomas
Nicola Veronese
Alexia Charles
Véronique Rabenda
Charlotte Beaudart
Cyrus Cooper
Jean-Yves Reginster
Olivier Bruyère
Publication date: 01-04-2019
Publisher: Springer International Publishing
Keywords: Osteoarthrosis
Diclofenac
Osteoarthrosis
Ketoprofen
Published in: Drugs & Aging / Issue Special Issue 1/2019
Print ISSN: 1170-229X
Electronic ISSN: 1179-1969
DOI: https://doi.org/10.1007/s40266-019-00661-0

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