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Miyake Y, Mitani S, Namba Y, Umehara N, Kawamoto T, Furuichi S. Efficacy of S-Flurbiprofen Plaster for Analgesia Following Total Hip Arthroplasty. Cureus 2024; 16:e66805. [PMID: 39280551 PMCID: PMC11398608 DOI: 10.7759/cureus.66805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2024] [Indexed: 09/18/2024] Open
Abstract
PURPOSE S-flurbiprofen (SFP) plaster, a non-steroidal anti-inflammatory drug preparation that penetrates effectively into deep tissue, is currently used as a conservative treatment for osteoarthritis. We investigated the analgesic and adverse effects of SFP plaster after total hip arthroplasty (THA). METHODS A retrospective comparative study identified 100 patients who underwent primary THA in our department. Group A consisted of 50 patients who received the selective cyclooxygenase-2 inhibitor celecoxib for 14 days after surgery, while Group B consisted of 50 patients who received SFP plaster for 14 days after surgery. We noted the numerical rating pain intensity scale (NRS) score, body temperature, and adverse effects of the analgesics. RESULTS Groups A and B showed no significant difference in NRS scores (p > 0.05). The body temperature was significantly higher in Group B than in Group A on days one, two, three, and five (p < 0.01). In Group A, two patients (4%) showed drug-induced renal dysfunction, and one patient (2%) showed gastrointestinal disturbance. Patients in Group B showed no systemic or local adverse effects. CONCLUSIONS The application of SFP plaster after THA provided an analgesic effect similar to that obtained with oral celecoxib without causing obvious side effects. Applying an SFP plaster may be an effective solution for postoperative analgesia.
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Affiliation(s)
- Yoshiaki Miyake
- Bone and Joint Surgery, Kawasaki Medical School, Kurashiki, JPN
| | - Shigeru Mitani
- Bone and Joint Surgery, Kawasaki Medical School, Kurashiki, JPN
| | - Yoshifumi Namba
- Bone and Joint Surgery, Kawasaki Medical School, Kurashiki, JPN
| | | | | | - Shuro Furuichi
- Bone and Joint Surgery, Kawasaki Medical School, Kurashiki, JPN
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Li D, Cheng Y, Yuan P, Wu Z, Liu J, Kan J, Zhang K, Wang Z, Zhang H, Zhang G, Xue T, Jia J, Zhai S, Guan Z. Efficacy and safety of flurbiprofen cataplasms versus loxoprofen sodium cataplasms in knee osteoarthritis: a randomized controlled trial. Chin Med J (Engl) 2023; 136:2187-2194. [PMID: 37545031 PMCID: PMC10508367 DOI: 10.1097/cm9.0000000000002797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Clinical trial evidence is limited to identify better topical non-steroidal anti-inflammatory drugs (NSAIDs) for treating knee osteoarthritis (OA). We aimed to compare the clinical efficacy and safety of flurbiprofen cataplasms (FPC) with loxoprofen sodium cataplasms (LSC) in treating patients with knee OA. METHODS This is an open-label, non-inferiority randomized controlled trial conducted at Peking University Shougang Hospital. Overall, 250 patients with knee OA admitted from October 2021 to April 2022 were randomly assigned to FPC and LSC treatment groups in a 1:1 ratio. Both medications were administered to patients for 28 days. The primary outcome was the change of pain measured by visual analog scale (VAS) score from baseline to day 28 (range, 0-10 points; higher score indicates worse pain; non-inferiority margin: 1 point; superiority margin: 0 point). There were four secondary outcomes, including the extent of pain relief, the change trends of VAS scores, joint function scores measured by the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and adverse events. RESULTS Among 250 randomized patients (One patient without complete baseline record in the flurbiprofen cataplasms was excluded; age, 62.8 ± 10.5 years; 61.4% [153/249] women), 234 (93.6%) finally completed the trial. In the intention-to-treat analysis, the decline of the VAS score for the 24-h most intense pain in the FPC group was non-inferior, and also superior to that in the LSC group (differences and 95% confidence interval, 0.414 (0.147-0.681); P <0.001 for non-inferiority; P = 0.001 for superiority). Similar results were observed of the VAS scores for the current pain and pain during exercise. WOMAC scores were also lower in the FPC group at week 4 (12.50 [8.00-22.50] vs . 16.00 [11.00-27.00], P = 0.010), mainly driven by the dimension of daily activity difficulty. In addition, the FPC group experienced a significantly lower incidence of adverse events (5.6% [7/124] vs . 33.6% [42/125], P <0.001), including irritation, rash and pain of the skin, and sticky hair uncovering pain. CONCLUSIONS This study suggested that FPC is superior to LSC for treating patients with knee OA in pain relief, joint function improvement, and safety profile.
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Affiliation(s)
- Dong Li
- Department of Orthopedic, Peking University Shougang Hospital, Beijing 100144, China
| | - Yinchu Cheng
- Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China
| | - Ping Yuan
- Department of Orthopedic, Peking University Shougang Hospital, Beijing 100144, China
| | - Ziyang Wu
- Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China
| | - Jiabang Liu
- Department of Orthopedic, Peking University Shougang Hospital, Beijing 100144, China
| | - Jinfu Kan
- Department of Orthopedic, Peking University Shougang Hospital, Beijing 100144, China
| | - Kun Zhang
- Department of Orthopedic, Peking University Shougang Hospital, Beijing 100144, China
| | - Zhanguo Wang
- Department of Orthopedic, Peking University Shougang Hospital, Beijing 100144, China
| | - Hui Zhang
- Department of Orthopedic, Peking University Shougang Hospital, Beijing 100144, China
| | - Guangwu Zhang
- Department of Orthopedic, Peking University Shougang Hospital, Beijing 100144, China
| | - Tao Xue
- Department of Orthopedic, Peking University Shougang Hospital, Beijing 100144, China
| | - Junxiu Jia
- Department of Orthopedic, Peking University Shougang Hospital, Beijing 100144, China
| | - Suodi Zhai
- Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China
| | - Zhenpeng Guan
- Department of Orthopedic, Peking University Shougang Hospital, Beijing 100144, China
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3
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Iguchi M, Takahashi T, Takeshita K. Effectiveness and Adherence Rate of S-flurbiprofen Plaster for the Pain Management of Patients With Moderate and End-Stage Knee Osteoarthritis. Cureus 2023; 15:e44556. [PMID: 37662513 PMCID: PMC10474442 DOI: 10.7759/cureus.44556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND S-flurbiprofen plaster (SFPP) is highly skin permeable and represents a new conservative treatment for knee osteoarthritis (KOA) that can attain considerably higher concentrations in the synovium than topical flurbiprofen. To date, no study has investigated the efficacy and adherence rate of SFPP in patients with end-stage KOA. This study aimed to compare the effectiveness and adherence rate of SFPP for pain management in patients with moderate and end-stage KOA. METHODS This retrospective study included a total of 118 patients with KOA (Kellgren-Lawrence classification grades II (n = 29), III (n = 32), and IV (n = 57)). The difference in SFPP use rate, adverse drug reactions rate, whether 50% pain relief occurred, and the percentage of patients who underwent surgical treatment were calculated. RESULTS The overall SFPP use rate at one year was 61.0% (88.1% at less than one month, 79.7% at three months, and 61.0% at six months), with no significant differences among Kellgren-Lawrence grade II, III, and IV groups (p = 0.538). Adverse drug reactions such as skin rash (n = 23), skin irritation (n = 8), and gastrointestinal disorders (n = 2) were observed. The one-year SFPP use rate was significantly lower in patients in whom these side effects occurred but did not decrease in patients in whom only a skin rash occurred. Overall, 19 patients underwent surgery after discontinuation of SFPP use. Surgery was statistically selected more by the "over 71 years of age" group (p = 0.038) and the "ineffective" group (p = 0.007). CONCLUSION SFPP exerts a comparable therapeutic effect even in end-stage KOA and may be an effective treatment option. Even if patients have end-stage KOA, there are cases in which the patient's background does not allow for surgery positively, such as high perioperative risk or desire for conservative treatment. In such cases, SFPP may be an effective treatment option worth trying.
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Affiliation(s)
- Masaki Iguchi
- Department of Orthopaedic Surgery, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, JPN
| | - Tsuneari Takahashi
- Department of Orthopaedic Surgery, Ishibashi General Hospital, Shimotsuke, JPN
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Shi C, Ye Z, Shao Z, Fan B, Huang C, Zhang Y, Kuang X, Miao L, Wu X, Zhao R, Chen X, Zhang B, Tong R, Hu X, Fu Z, Lin J, Li X, Sun T, Liu G, Dai H, Guo C, Zhang B, Xu T, Wen A, Zuo X, Liu J, Chen X, Li H, Wang J, Luo M, Fan T, Qian Y, Li X, Qiu W, Lin X, Pang Y, Hou Y, Yao D, Kou W, Sun B, Hu C, Xia Y, Zhao M, Zhu C, Li Q, Zhang Y. Multidisciplinary Guidelines for the Rational Use of Topical Non-Steroidal Anti-Inflammatory Drugs for Musculoskeletal Pain (2022). J Clin Med 2023; 12:jcm12041544. [PMID: 36836078 PMCID: PMC9966446 DOI: 10.3390/jcm12041544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/03/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
(1) Background: Topical non-steroidal anti-inflammatory drugs (NSAIDs) are one of the primary drugs for treating musculoskeletal pain. However, there are currently no evidence-based recommendations about drug selection, drug administration, drug interactions, and use in special populations or other pharmacology-related content of such medications. To this end, the Chinese Pharmaceutical Association Hospital Pharmacy Professional Committee developed multidisciplinary guidelines on using topical NSAIDs to treat musculoskeletal pain. (2) Methods: The guidelines development process followed the World Health Organization guideline development handbook, the GRADE methodology, and the statement of Reporting Items for Practice Guidelines in Healthcare. The guideline panel used the Delphi method to identify six clinical questions to be addressed in the guidelines. An independent systematic review team conducted a systematic search and integration of evidence. (3) Results: Based on the balance between the benefits and harms of an intervention, the quality of the evidence, patient preferences and values, and resource utilization, the guideline panel developed 11 recommendations and nine expert consensuses on using topical NSAIDs to treat acute and chronic musculoskeletal pain. (4) Conclusions: Based on the effectiveness and overall safety of topical NSAIDs, we recommend patients with musculoskeletal pain use topical NSAIDs and suggest high-risk patients use topical NSAIDs, such as those with other diseases or receiving other concurrent treatments. The evidenced-based guidelines on topical NSAIDs for musculoskeletal pain incorporated a pharmacist perspective. The guidelines have the potential to facilitate the rational use of topical NSAIDs. The guideline panel will monitor the relevant evidence and update the recommendations accordingly.
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Affiliation(s)
- Chen Shi
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan 430022, China
- Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, Wuhan 430022, China
| | - Zhaoming Ye
- Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Zengwu Shao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan 430022, China
| | - Bifa Fan
- Department of Pain Management, China-Japan Friendship Hospital, Beijing 100029, China
| | - Cibo Huang
- Department of Rheumatology, South China Hospital, Health Science Center, Shenzhen University, Shenzhen 518116, China
| | - Yuan Zhang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Xinying Kuang
- Global Health Nursing, St. Luke’s International University, Tokyo 104-0044, Japan
| | - Liyan Miao
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Xin’an Wu
- Department of Pharmacy, The First Hospital of Lanzhou University, Gansu 730000, China
| | - Rongsheng Zhao
- Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing 100191, China
| | - Xiao Chen
- Department of Pharmacy, The First Affiliated Hospital of Sun Yet-sen University, Guangzhou 510080, China
| | - Bikui Zhang
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Rongsheng Tong
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, Chengdu 610072, China
| | - Xin Hu
- Department of Pharmacy, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Key Laboratory of Drug Clinical Risk and Personalized Medication Evaluation, Beijing 100730, China
| | - Zhijian Fu
- Department of Pain Management, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Jianhao Lin
- Arthritis Clinic and Research Center, Peking University Peoples Hospital, 11 Xizhimen South Street, Xicheng District, Beijing 100044, China
| | - Xiaomei Li
- Department of Rheumatology and Immunology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Lujiang Str. 17, Hefei 230001, China
| | - Tiezheng Sun
- Arthritis Clinic and Research Center, Peking University Peoples Hospital, 11 Xizhimen South Street, Xicheng District, Beijing 100044, China
| | - Guoqiang Liu
- Department of Clinical Pharmacy, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - Haibin Dai
- Department of Pharmacy, Second Affiliated Hospital of Zhejiang University School of Medicine, Research Center for Clinical Pharmacy, Zhejiang University, Hangzhou 310009, China
| | - Cheng Guo
- Department of Pharmacy, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
| | - Bo Zhang
- Department of Pharmacy, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
| | - Ting Xu
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Aidong Wen
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Xiaocong Zuo
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Jinmei Liu
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan 430022, China
- Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, Wuhan 430022, China
| | - Xu Chen
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan 430022, China
- Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, Wuhan 430022, China
| | - Huibo Li
- Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing 100191, China
| | - Jing Wang
- Department of Pharmacy, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
| | - Min Luo
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Tingting Fan
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Yulan Qian
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Xiu’mao Li
- Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Wenjie Qiu
- Department of Rheumatology, South China Hospital, Health Science Center, Shenzhen University, Shenzhen 518116, China
| | - Xiaowen Lin
- Department of Pain Management, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Yingchang Pang
- Arthritis Clinic and Research Center, Peking University Peoples Hospital, 11 Xizhimen South Street, Xicheng District, Beijing 100044, China
| | - Yunfei Hou
- Arthritis Clinic and Research Center, Peking University Peoples Hospital, 11 Xizhimen South Street, Xicheng District, Beijing 100044, China
| | - Difei Yao
- Department of Pharmacy, Second Affiliated Hospital of Zhejiang University School of Medicine, Research Center for Clinical Pharmacy, Zhejiang University, Hangzhou 310009, China
| | - Wen Kou
- Department of Pharmacy, The First Hospital of Lanzhou University, Gansu 730000, China
| | - Bao Sun
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Can Hu
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Yanzhe Xia
- Department of Pharmacy, The First Affiliated Hospital of Sun Yet-sen University, Guangzhou 510080, China
| | - Ming Zhao
- Department of Pharmacy, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Key Laboratory of Drug Clinical Risk and Personalized Medication Evaluation, Beijing 100730, China
| | - Changyu Zhu
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, Chengdu 610072, China
| | - Qian Li
- Department of Clinical Pharmacy, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - Yu Zhang
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan 430022, China
- Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, Wuhan 430022, China
- Correspondence:
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5
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Song P, Cui Z, Hu L. Applications and prospects of intra-articular drug delivery system in arthritis therapeutics. J Control Release 2022; 352:946-960. [PMID: 36375618 DOI: 10.1016/j.jconrel.2022.11.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/06/2022] [Accepted: 11/08/2022] [Indexed: 11/17/2022]
Abstract
Arthritis is a kind of chronic disease that affects joints and muscles with the symptoms of joint pain, inflammation and limited movement of joints. Among various clinical therapies, drug therapy has been extensively applied because of its accessibility, safety and effectiveness. In recent years, the intra-articular injection has dramatic therapeutic effects in treating arthritis with high patient compliance and low side effects. In this review, we will introduce pathology of arthritis, along with the accessible treatment and diagnosis methods, then we will summarize major advances of current hopeful intra-articular delivery systems such as microspheres, hydrogels, nanoparticles and liposomes. At last, some safety assessments in the preclinical work and the main challenges for the further development of intra-articular treatment were also discussed.
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Affiliation(s)
- Pengjin Song
- Key Laboratory of Pharmaceutical Quality Control of Hebei Province, School of Pharmaceutical Sciences, Hebei University, Baoding 071000, China
| | - Zhe Cui
- Key Laboratory of Pharmaceutical Quality Control of Hebei Province, School of Pharmaceutical Sciences, Hebei University, Baoding 071000, China.
| | - Liandong Hu
- Key Laboratory of Pharmaceutical Quality Control of Hebei Province, School of Pharmaceutical Sciences, Hebei University, Baoding 071000, China.
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Hunter CW, Deer TR, Jones MR, Chang Chien GC, D’Souza RS, Davis T, Eldon ER, Esposito MF, Goree JH, Hewan-Lowe L, Maloney JA, Mazzola AJ, Michels JS, Layno-Moses A, Patel S, Tari J, Weisbein JS, Goulding KA, Chhabra A, Hassebrock J, Wie C, Beall D, Sayed D, Strand N. Consensus Guidelines on Interventional Therapies for Knee Pain (STEP Guidelines) from the American Society of Pain and Neuroscience. J Pain Res 2022; 15:2683-2745. [PMID: 36132996 PMCID: PMC9484571 DOI: 10.2147/jpr.s370469] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/12/2022] [Indexed: 11/23/2022] Open
Abstract
Knee pain is second only to the back as the most commonly reported area of pain in the human body. With an overall prevalence of 46.2%, its impact on disability, lost productivity, and cost on healthcare cannot be overlooked. Due to the pervasiveness of knee pain in the general population, there are no shortages of treatment options available for addressing the symptoms. Ranging from physical therapy and pharmacologic agents to interventional pain procedures to surgical options, practitioners have a wide array of options to choose from - unfortunately, there is no consensus on which treatments are "better" and when they should be offered in comparison to others. While it is generally accepted that less invasive treatments should be offered before more invasive ones, there is a lack of agreement on the order in which the less invasive are to be presented. In an effort to standardize the treatment of this extremely prevalent pathology, the authors present an all-encompassing set of guidelines on the treatment of knee pain based on an extensive literature search and data grading for each of the available alternative that will allow practitioners the ability to compare and contrast each option.
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Affiliation(s)
- Corey W Hunter
- Ainsworth Institute of Pain Management, New York, NY, USA
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Timothy R Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA
| | | | | | - Ryan S D’Souza
- Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA
| | | | - Erica R Eldon
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Johnathan H Goree
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Lissa Hewan-Lowe
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jillian A Maloney
- Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Anthony J Mazzola
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | - Jeanmarie Tari
- Ainsworth Institute of Pain Management, New York, NY, USA
| | | | | | - Anikar Chhabra
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, USA
| | | | - Chris Wie
- Interventional Spine and Pain, Dallas, TX, USA
| | - Douglas Beall
- Comprehensive Specialty Care, Oklahoma City, OK, USA
| | - Dawood Sayed
- Department of Anesthesiology, Division of Pain Medicine, University of Kansas Medical Center, Kansas City, KS, USA
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Tomatsu K, Yasuda S, Fuady A, Matsumoto H, Sumariyono. Efficacy and safety of S-flurbiprofen plaster in knee osteoarthritis patients: A 2-week randomized controlled Phase III clinical trial compared to diclofenac gel. Int J Rheum Dis 2022; 25:563-570. [PMID: 35199483 PMCID: PMC9303700 DOI: 10.1111/1756-185x.14307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/01/2022] [Accepted: 02/07/2022] [Indexed: 11/30/2022]
Abstract
Aim S‐flurbiprofen plaster (SFPP) is a novel topical nonsteroidal anti‐inflammatory drug (NSAID) patch. This study aimed to assess the efficacy and safety of SFPP in knee osteoarthritis (OA) patients compared to diclofenac gel. Methods This study was a multicenter, randomized, active‐controlled, open‐label, non‐inferiority phase III trial. There were 311 enrolled patients treated by SFPP or diclofenac gel for 2 weeks. The primary efficacy outcome was the knee pain when rising from the specially arranged chair assessed by visual analog scale (rVAS). The other efficacy outcomes were clinical symptoms, pain on walking, global assessment by both investigator and patient, and use/non‐use of the rescue drugs during the treatment period. Adverse events (AEs) were evaluated as the safety outcome. Results The least‐squares mean (95% CI) of ΔrVAS at the end of the study was 41.52 (39.16‐43.88) mm in the SFPP group and 36.01 (33.69‐38.33) mm in the diclofenac gel group, with a between‐group difference of 5.51 (2.20‐8.82), indicating non‐inferiority. There were statistically significant differences between the groups in rVAS, clinical symptoms, pain on walking, and the global assessment by both investigator and patient. The incidence rate of AEs in the SFPP group was 5.8%, and there was no statistically significant difference from that in the diclofenac gel group (5.2%). Most of the AEs were mild, and no AE led to discontinuation. Conclusion Non‐inferiority of SFPP to diclofenac gel was demonstrated in the efficacy for pain on rising from a chair. SFPP was also well‐tolerated in knee OA patients.
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Affiliation(s)
- Kenji Tomatsu
- International Business Headquarter, Taisho Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Shoji Yasuda
- International Business Headquarter, Taisho Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Ahmad Fuady
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Hideo Matsumoto
- Public Interest Incorporated Foundation, Japan Sports Medicine Foundation, Tokyo, Japan
| | - Sumariyono
- Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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8
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Koyama K. Comparison of efficacy and safety in the combination therapies of duloxetine and S-flurbiprofen plaster, and of duloxetine and conventional NSAIDs for chronic pain in patients with osteoarthritis (OASIS DUAL study). Drug Discov Ther 2022; 16:217-224. [DOI: 10.5582/ddt.2022.01052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Kenzo Koyama
- Nagasaki Orthopaedic Koyama Clinic, Nagayo, Nishisonogi, Nagasaki, Japan
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9
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Amemiya M, Nakagawa Y, Yoshimura H, Takahashi T, Inomata K, Nagase T, Ju YJ, Shimaya M, Tsukada S, Hirasawa N, Koga H. Comparison of tissue pharmacokinetics of esflurbiprofen plaster with flurbiprofen tablets in patients with knee osteoarthritis: A multicenter randomized controlled trial. Biopharm Drug Dispos 2021; 42:418-426. [PMID: 34529839 PMCID: PMC9293315 DOI: 10.1002/bdd.2302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 08/27/2021] [Accepted: 09/10/2021] [Indexed: 11/18/2022]
Abstract
This open‐label, multicenter, prospective, randomized controlled trial aimed to determine the effectiveness of esflurbiprofen plaster (SFPP) and flurbiprofen tablets (FPTs) on knee osteoarthritis in patients scheduled for total knee arthroplasty by comparing the transfer of esflurbiprofen and flurbiprofen to tissues and fluids. Thirty‐eight patients were randomly assigned in a 1:1 ratio to receive SFPP or FPT. Both groups were then divided into four subgroups, according to whether they received the final dose of SFPP or FPT at 2, 7, 12, or 24 h before planned surgery. The primary endpoints were the esflurbiprofen concentrations in synovium, synovial fluid, and plasma. Areas under concentration–time curves (AUC0–24 h) of esflurbiprofen were calculated for each group. Pain was assessed using a numeric rating scale (NRS) 7 days before and immediately before surgery. The AUC0–24 h in the synovium were 4401.24 and 4862.70 ng·h/g in the SFPP and FPT groups, respectively. Maximum esflurbiprofen concentrations were observed in the synovium, synovial fluids, and plasma after SFPP application for 12 h. The NRS results indicated a long‐lasting effect of SFPP. The AUC of the synovial esflurbiprofen concentration of SFPP indicated that the SFPP is transferred to the synovium and synovial fluid in high concentration. The efficient deep‐tissue transfer of esflurbiprofen suggests that its pharmacokinetic characteristics differ from those of conventional topical NSAIDs. This study was prospectively registered in the Japan Registry of Clinical Trials (registration number: jRCTs031180228).
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Affiliation(s)
- Masaki Amemiya
- Department of Joint Surgery and Sport Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yusuke Nakagawa
- Department of Joint Surgery and Sport Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hideya Yoshimura
- Department of Orthopaedic Surgery, Kawaguchikogyo General Hospital, Saitama, Japan
| | - Toru Takahashi
- Department of Orthopaedic Surgery, Kawaguchikogyo General Hospital, Saitama, Japan
| | - Kei Inomata
- Department of Orthopaedic Surgery, Doai Memorial Hospital, Tokyo, Japan
| | - Tsuyoshi Nagase
- Department of Orthopaedic Surgery, Doai Memorial Hospital, Tokyo, Japan
| | - Young-Jin Ju
- Department of Orthopaedic Surgery, Tama-Hokubu Medical Center, Tokyo, Japan
| | - Masayuki Shimaya
- Department of Orthopaedic Surgery, Nerima General Hospital, Tokyo, Japan
| | - Sachiyuki Tsukada
- Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, Ibaraki, Japan
| | - Naoyuki Hirasawa
- Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, Ibaraki, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sport Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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10
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Sasaki S, Sasaki E, Kimura Y, Naraoka T, Yamamoto Y, Tsuda E, Ishibashi Y. Treatment Efficacy of Single Topical NSAID (S-Flurbiprofen Plaster) for Knee Symptoms and Locomotive Dysfunction in Knee Osteoarthritis Patients. Prog Rehabil Med 2021; 6:20210029. [PMID: 34316523 PMCID: PMC8290354 DOI: 10.2490/prm.20210029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/07/2021] [Indexed: 11/15/2022] Open
Abstract
Objective: The aim of this study was to demonstrate the non-inferiority of S-flurbiprofen plaster
(SFPP) monotherapy for treating knee osteoarthritis compared with the combination of
conventional oral and topical non-steroidal anti-inflammatory drugs (NSAIDs). Methods: A total of 222 participants (114, SFPP group; 108, control group) were treated for 4
weeks. The primary endpoint was the change in the degree of pain felt while rising from
a chair after 2 and 4 weeks of treatment as determined using the visual analog scale
(VAS) . The secondary endpoint was the change in functional scores and test results.
Safety was evaluated in terms of the adverse effects. Results: The VAS score significantly decreased in both groups after 2 and 4 weeks of treatment.
Non-inferiority in the VAS score was established only at 2 weeks. There were no
significant differences in the secondary endpoints between the groups. Skin disorders
were more frequent in the SFPP group; however, there was no difference in
gastrointestinal (GI) adverse effects. Conclusions: The therapeutic efficacy of SFPP monotherapy for knee OA, with respect to changes in
the VAS, was not shown to be non-inferior to conventional treatment at 4 weeks; however,
non-inferiority was established at 2 weeks. The functional improvement in the SFPP group
was comparable to that of the control group. No severe GI adverse effects associated
with SFPP administration were observed; however, it is necessary to pay more attention
to the occurrence of skin disorders with SFPP than with conventional topical NSAIDs.
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Affiliation(s)
- Shizuka Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Eiji Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuka Kimura
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takuya Naraoka
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuji Yamamoto
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Eiichi Tsuda
- Department of Rehabilitation Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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11
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Tsuji M, Kobayashi N, Yukizawa Y, Oishi T, Takagawa S, Inaba Y. Effect of Flurbiprofen and S-Flurbiprofen Patches on Multimodal Pain Management After Total Knee Arthroplasty: A Prospective Randomized Controlled Trial. J Arthroplasty 2020; 35:2033-2038. [PMID: 32362479 DOI: 10.1016/j.arth.2020.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/23/2020] [Accepted: 04/03/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is an established procedure for knee osteoarthritis. Multimodal analgesia is reportedly more effective for postoperative analgesia. We investigated the efficacy of 2 patches after TKA. METHODS Seventy-nine knees that underwent unilateral TKA for osteoarthritis were included. Oral administration, local periarticular analgesic injection, and patches were adopted for pain management. The knees were randomly assigned to the flurbiprofen patch (FPP), S-flurbiprofen patch (SFPP), and control (no patch) groups. Patch treatment was continued for 14 days. Pain according to the visual analog scale, knee flexion angle, renal dysfunction, gastrointestinal injury, duration of hospitalization, dermatitis, and the rate of using additional oral nonsteroidal anti-inflammatory drugs were compared (from preoperative to postoperative day 14). RESULTS The FPP, SFPP, and control groups included 29, 27, and 23 knees, respectively. Visual analog scale was lower in the FPP and SFPP groups than in the control group on days 1 and 3 (day 1: 24.4, 25.0, and 39.4, respectively; day 3: 25.5, 23.3, and 39.3, respectively). Knee flexion angle was larger in the SFPP group than in the control group on days 7 and 14 (day 7: 89.8° and 76.6°, respectively; day 14: 98.3° and 84.2°, respectively). Neither renal dysfunction nor gastrointestinal injury was confirmed. The duration of hospitalization did not differ among the groups. Dermatitis occurred only in the SFPP group. The rate of using additional oral nonsteroidal anti-inflammatory drugs was higher in the control group. CONCLUSION Both patches were effective and safe as part of multimodal analgesia for postoperative TKA.
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Affiliation(s)
- Masaki Tsuji
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Naomi Kobayashi
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Yohei Yukizawa
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Takayuki Oishi
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Shu Takagawa
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama, Japan
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12
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Cui X, Ding Q, Shan RN, He CH, Wu KJ. Enantioseparation of flurbiprofen enantiomers using chiral ionic liquids by liquid-liquid extraction. Chirality 2019; 31:457-467. [PMID: 31062890 DOI: 10.1002/chir.23071] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 03/01/2019] [Accepted: 03/29/2019] [Indexed: 12/14/2022]
Abstract
Flurbiprofen is a kind of nonsteroidal anti-inflammatory drug, which has been widely used in clinic for treatment of rheumatoid arthritis and osteoarthritis. It has been reported that S-flurbiprofen shows good performance on clinic anti-inflammatory treatment, while R-enantiomer almost has no pharmacological activities. It has important practical values to obtain optically pure S-flurbiprofen. In this work, chiral ionic liquids, which have good structural designability and chiral recognize ability, were selected as the extraction selector by the assistance of quantum chemistry calculations. The distribution behaviors of flurbiprofen enantiomers were investigated in the extraction system, which was composed of organic solvent and aqueous phase containing chiral ionic liquid. The results show that maximum enantioselectivity up to 1.20 was attained at pH 2.0, 25°C using 1,2-dichloroethane as organic solvent, 1-butyl-3-methylimidazole L-tryptophan ([Bmim][L-trp]) as chiral selector. The racemic flurbiprofen initial concentration was 0.2 mmol L-1 , and [Bmim][L-trp] concentration was 0.02 mol L-1 . Furthermore, the recycle of chiral ionic liquids has been achieved by reverse extraction process of the aqueous phase with chiral selector, which is significant for industrial application of chiral ionic liquids and scale-up of the extraction process.
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Affiliation(s)
- Xing Cui
- Zhejiang Provincial Key Laboratory of Advanced Chemical Engineering Manufacture Technology, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou, China.,Institute of Zhejiang University-Quzhou, Quzhou, China
| | - Qi Ding
- Zhejiang Provincial Key Laboratory of Advanced Chemical Engineering Manufacture Technology, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou, China.,Institute of Zhejiang University-Quzhou, Quzhou, China
| | - Ruo-Ni Shan
- Zhejiang Provincial Key Laboratory of Advanced Chemical Engineering Manufacture Technology, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou, China.,Institute of Zhejiang University-Quzhou, Quzhou, China
| | - Chao-Hong He
- Zhejiang Provincial Key Laboratory of Advanced Chemical Engineering Manufacture Technology, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou, China.,Institute of Zhejiang University-Quzhou, Quzhou, China
| | - Ke-Jun Wu
- School of Chemical and Process Engineering, University of Leeds, Leeds, UK
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13
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Persson MSM, Stocks J, Walsh DA, Doherty M, Zhang W. The relative efficacy of topical non-steroidal anti-inflammatory drugs and capsaicin in osteoarthritis: a network meta-analysis of randomised controlled trials. Osteoarthritis Cartilage 2018; 26:1575-1582. [PMID: 30172837 PMCID: PMC6267943 DOI: 10.1016/j.joca.2018.08.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 07/23/2018] [Accepted: 08/16/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the efficacy of topical non-steroidal anti-inflammatory drugs (NSAIDs) with topical capsaicin for pain relief in osteoarthritis (OA). DESIGN A systematic literature search was conducted for randomised controlled trials (RCTs) examining any topical NSAID or capsaicin in OA. Pain relief at or nearest to 4 weeks was pooled using a random-effects network meta-analysis (NMA) in a Frequentist and Bayesian setting. Analysis was conducted for all trials and for trials using drugs listed as licensed for OA in the British National Formulary (BNF). RESULTS The trial network comprised 28 RCTs (7372 participants), of which 17 RCTs (3174 participants) were included in the as licensed analyses. No RCTs directly compared topical NSAIDs with capsaicin. Placebo was the only common comparator for topical NSAIDs and capsaicin. Frequentist and Bayesian effect size (ES) estimates were in agreement. Topical NSAIDs were statistically superior to placebo overall (ES 0.30, 95% confidence interval [CI] 0.19 to 0.41) and as licensed (ES 0.32, 95% CI 0.24 to 0.39). However, capsaicin was only statistically superior to placebo when used at licensed doses (ES 0.41, 95% CI 0.17 to 0.64). No significant differences were observed in pain relief between topical NSAIDs and capsaicin (overall: ES 0.04, 95% CI -0.26 to 0.33; as licensed: ES-0.09, 95% CI -0.34 to 0.16). CONCLUSIONS Current evidence indicates that topical NSAIDs and capsaicin in licensed doses may be equally effective for pain relief in OA. Whether the equivalence varies between individuals remains unknown.
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Affiliation(s)
- M S M Persson
- Academic Rheumatology, Division of Rheumatology, Orthopaedics, and Dermatology, University of Nottingham, UK; Arthritis Research UK Pain Centre, UK.
| | - J Stocks
- Academic Rheumatology, Division of Rheumatology, Orthopaedics, and Dermatology, University of Nottingham, UK; Arthritis Research UK Pain Centre, UK.
| | - D A Walsh
- Academic Rheumatology, Division of Rheumatology, Orthopaedics, and Dermatology, University of Nottingham, UK; Arthritis Research UK Pain Centre, UK.
| | - M Doherty
- Academic Rheumatology, Division of Rheumatology, Orthopaedics, and Dermatology, University of Nottingham, UK; Arthritis Research UK Pain Centre, UK.
| | - W Zhang
- Academic Rheumatology, Division of Rheumatology, Orthopaedics, and Dermatology, University of Nottingham, UK; Arthritis Research UK Pain Centre, UK.
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14
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Otsuka N, Yataba I. [Pharmacological action and clinical outcome of newly developed NSAIDs patch, "LOQOA ® tape"]. Nihon Yakurigaku Zasshi 2018; 151:221-227. [PMID: 29760367 DOI: 10.1254/fpj.151.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Topical non-steroidal anti-inflammatory drugs (NSAIDs) patches are indispensable for the treatment of musculoskeletal diseases, while they are considered less effective than oral NSAIDs. LOQOA® tape is a tape-type patch containing esflurbiprofen (SFP) as a major active ingredient with potent cyclooxygenase inhibition and sufficient skin permeability. SFP patch (SFPP) showed higher percutaneous absorption rate, rapid pain relief, and potent anti-inflammatory efficacy comparing with existing NSAIDs patches in rat. SFPP showed dramatically higher synovial fluid and tissue concentration on SFP than that of flurbiprofen (FP) patch after single application to knee osteoarthritis (OA) patients. On the other hand, clinical dosage of SFPP was determined as not more than two patches a day from the estimation of systemic exposure to SFP of SFPP and oral FP. SFPP showed statistically significant differences in pain relief and all the other efficacy end points compared to inactive placebo or FP patch in knee OA patients. Efficacy on OA other than knee joint was also observed. In long-term study of SFPP, using up to two patches a day, a total of 201 patients was included and 161 patients achieved 52-week application. Among drug-related side effects, skin reaction at the application sites was observed in 46.8% and discontinued in 4.3%. Although gastro-intestinal reaction and abnormal changes in laboratory tests related to kidney function were observed as systemic drug-related side effects, most of them were mild in severity. SFPP, the new generation NSAIDs patch, would be one of effective options for the treatment of symptomatic OA patients.
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Affiliation(s)
- Noboru Otsuka
- Senior Specialist Office and Business Planning and Development Division for International Business, Taisho Pharmaceutical Co., Ltd
| | - Ikuko Yataba
- Regulatory Affairs, Taisho Pharmaceutical Co., Ltd
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15
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Fukumoto A, Tajima K, Hori M, Toda Y, Kaku S, Matsumoto H. Analgesic effect of S (+)-flurbiprofen plaster in a rat model of knee arthritis: analysis of gait and synovial fluid prostaglandin E 2 levels. J Pharm Pharmacol 2018; 70:929-936. [PMID: 29607510 PMCID: PMC6033094 DOI: 10.1111/jphp.12914] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 03/03/2018] [Indexed: 12/18/2022]
Abstract
Objectives We developed S (+)‐flurbiprofen plaster (SFPP), a novel NSAID patch containing S (+)‐flurbiprofen (SFP), a potent cyclooxygenase (COX) inhibitor. The purpose of this study was to assess efficacy of SFPP by analysing its effect on the gait disturbance and measuring the prostaglandin E2 (PGE2) production in synovial fluid in a rat model of knee arthritis. Methods Knee inflammation was induced in rats by intra‐articular injection of a yeast suspension. Subsequently, an NSAID patch containing SFP, ketoprofen or loxoprofen was applied over the affected knee. Gait was assessed at 2, 4 and 6 h after application of the patch. The PGE2 concentration in the synovial fluid was measured after the gait assessment. Key findings Application of SFPP (0.125, 0.25, 0.5 or 1 mg/sheet) was followed by a decrease in the visual gait score at all the doses examined. In the case of the other two NSAID patches, only the ketoprofen patch (1 or 2 mg/sheet) and loxoprofen patch (5 mg/sheet) produced a decrease in the visual gait score. All of the NSAID patches decreased the PGE2 production in the synovial fluid. Conclusions These results suggest the potential usefulness of SFPP as an analgesic patch in patients with inflammatory joint pain.
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Affiliation(s)
- Ayaka Fukumoto
- Pharmacology Laboratories, Taisho Pharmaceutical Co., Ltd., Saitama, Japan
| | - Kyoko Tajima
- Pharmacology Laboratories, Taisho Pharmaceutical Co., Ltd., Saitama, Japan
| | - Miyuki Hori
- Pharmacology Laboratories, Taisho Pharmaceutical Co., Ltd., Saitama, Japan
| | - Yoshihisa Toda
- Pharmaceutical Business Strategic Planning, Taisho Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Shinsuke Kaku
- Pharmacology Laboratories, Taisho Pharmaceutical Co., Ltd., Saitama, Japan
| | - Hideo Matsumoto
- Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan
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16
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Nelson AE. Osteoarthritis year in review 2017: clinical. Osteoarthritis Cartilage 2018; 26:319-325. [PMID: 29229563 PMCID: PMC5835411 DOI: 10.1016/j.joca.2017.11.014] [Citation(s) in RCA: 234] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 11/14/2017] [Accepted: 11/30/2017] [Indexed: 02/07/2023]
Abstract
This review is based on a systematic review of the literature relevant to clinical topics in osteoarthritis (OA) performed for the time period February 22, 2016 to April 1, 2017. A PubMed search using the terms "osteoarthritis" and "treatment or epidemiology" returned over 800 papers, of which 57 are reviewed here, with inclusion primarily based on relevance to clinical OA. Epidemiologic studies in this time frame focused on the incidence and prevalence of OA, comorbidities and mortality in relation to OA (particularly obesity and cardiovascular disease), and multiple joint involvement. Papers on therapeutic approaches to OA considered: non-pharmacologic options, a number of topical, oral, and intra-articular therapies, as well as the cost-effectiveness of some OA treatments. There an enormous need to identify novel strategies to reduce the impact of this highly prevalent and debilitating condition.
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Affiliation(s)
- Amanda E. Nelson
- Thurston Arthritis Research Center and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7280, USA
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17
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Maniar KH, Jones IA, Gopalakrishna R, Vangsness CT. Lowering side effects of NSAID usage in osteoarthritis: recent attempts at minimizing dosage. Expert Opin Pharmacother 2017; 19:93-102. [PMID: 29212381 DOI: 10.1080/14656566.2017.1414802] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Osteoarthritis is a burdensome disease that causes progressive damage to articular cartilage. Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the preferred treatments for symptomatic relief. However, NSAIDs can cause serious dose-dependent side effects, which has prompted experts to recommend the minimization of NSAID dosage. AREAS COVERED This review focuses on three broad strategies that are currently being investigated or implemented to minimize NSAID dosage: nano-formulation, encapsulation, and topical delivery. The benefits, challenges and current status of these methods are discussed. EXPERT OPINION Multiple strategies are under investigation to lower NSAID dosage. There is great potential in developing formulations that utilize more than one of these strategies together. However, there are challenges to developing these lower dose preparations. In order to maximize the clinical potential of the abundance of NSAIDs that are both available and being developed, there is a major need for additional clinical studies directly comparing safety and efficacy of different preparations.
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Affiliation(s)
- Kevin H Maniar
- a Keck School of Medicine of USC , Los Angeles , CA , USA
| | - Ian A Jones
- b Department of Orthopaedic Surgery , Keck School of Medicine of USC , Los Angeles , CA , USA
| | - Rayudu Gopalakrishna
- c Department of Integrative Anatomical Sciences , Keck School of Medicine of USC , Los Angeles , CA , USA
| | - C Thomas Vangsness
- b Department of Orthopaedic Surgery , Keck School of Medicine of USC , Los Angeles , CA , USA
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18
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Harkness GJ, Clarke ML. A Highly Enantioselective Alkene Methoxycarbonylation Enables a Concise Synthesis of (S)-Flurbiprofen. European J Org Chem 2017. [DOI: 10.1002/ejoc.201700791] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Gavin J. Harkness
- School of Chemistry; University of St Andrews; EaStCHEM; KY16 9ST St Andrews Fife Scotland, UK
| | - Matthew L. Clarke
- School of Chemistry; University of St Andrews; EaStCHEM; KY16 9ST St Andrews Fife Scotland, UK
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19
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Otsuka N, Yataba I, Matsushita I, Matsumoto H, Hoshino Y, Terada Y. A minimal impact of long-term S-flurbiprofen plaster application on kidney function in osteoarthritis patients. Clin Exp Nephrol 2017; 21:1060-1067. [PMID: 28378068 PMCID: PMC5698367 DOI: 10.1007/s10157-017-1406-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 03/27/2017] [Indexed: 11/07/2022]
Abstract
Background The number of kidney injury due to nonsteroidal anti-inflammatory drugs (NSAIDs) is the largest among drug-induced kidney diseases. Newly developed NSAID plaster containing S-flurbiprofen (SFP) shows innovative percutaneous absorption. However, systemic exposure to SFP following the repeated application of 80 mg/day was estimated as comparable to that of oral 120 mg/day flurbiprofen and prolonged use of topical NSAIDs is common in clinical practice. Thus, we report the safety focusing on the kidney function after long-term application of SFP plaster (SFPP). Methods A total of 201 osteoarthritis patients (mean age; 66.3, 151 females, mean estimated glomerular filtration rate; 74.6 mL/min/1.73 mm2) were applied 40 or 80 mg SFPP for 52 weeks, and kidney function was examined by blood urea nitrogen (BUN), serum creatinine (SCr), eGFR, and urinalysis. Results 161 (80.1%) patients completed 52-week application. In both groups of 40 and 80 mg, small but statistically significant increases were observed in BUN (mean 1.91 and 1.89 mg/dL, p < 0.05) and SCr (mean 0.019 and 0.022 mg/dL, p < 0.05). Although abnormal changes in laboratory test for renal function were observed in seven patients, all the changes were small and subclinical. Acute kidney injury was observed in two patients. Meanwhile, the investigators denied the relevance of SFPP according to the clinical course. Conclusion Toward the end of 52-week application, a statistically significant increase in SCr was observed in both 40 and 80 mg, but increment was small and subclinical. Attention should be paid to kidney function when applying SFPP to patients with multiple risk factors.
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Affiliation(s)
- Noboru Otsuka
- Development Headquarters, Taisho Pharmaceutical Co., Ltd., 3-24-1 Takada, Toshima-ku, Tokyo, 170-8633, Japan.
| | - Ikuko Yataba
- Development Headquarters, Taisho Pharmaceutical Co., Ltd., 3-24-1 Takada, Toshima-ku, Tokyo, 170-8633, Japan
| | - Isao Matsushita
- Development Headquarters, Taisho Pharmaceutical Co., Ltd., 3-24-1 Takada, Toshima-ku, Tokyo, 170-8633, Japan
| | - Hideo Matsumoto
- Institute for Integrated Sports Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yuichi Hoshino
- Orthopedics Surgery, School of Medicine, Jichi Medical University, 3111-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Yoshio Terada
- Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
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20
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Yataba I, Otsuka N, Matsushita I, Matsumoto H, Hoshino Y. The Long-Term Safety of S-Flurbiprofen Plaster for Osteoarthritis Patients: An Open-Label, 52-Week Study. Clin Drug Investig 2016; 36:673-82. [PMID: 27229525 PMCID: PMC4951513 DOI: 10.1007/s40261-016-0412-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background and objectives The newly developed S-flurbiprofen plaster (SFPP) is a tape-type patch that shows innovative percutaneous absorption. This study was designed to evaluate the safety of a long-term 52-week SFPP application to osteoarthritis (OA) patients. Methods This was a multi-center, open-label, uncontrolled prospective study that included 201 OA patients. SFPP at 40 mg/day was applied to the site of pain in 101 patients and at 80 mg/day (2 patches) in 100 patients at a total of 301 sites for 52 weeks. The affected sites assessed included the knee (192), lumbar spine (66), cervical spine (26), and others (17). Drug safety was evaluated by medical examination, laboratory tests, and examination of vital signs. Efficacy was evaluated by the patient’s and clinician’s global assessments and clinical symptoms. Results Most patients (80.1 %) completed the 52-week SFPP application. The majority of drug-related adverse events (AEs) included mild dermatitis at the application sites and occurred in 46.8 % of the sites. No photosensitive dermatitis was observed. Systemic AEs occurred in 9.0 % of the patients; a serious AE (gastric ulcer hemorrhage) occurred in one patient. No clinically significant changes in the laboratory tests and vital signs were observed. The efficacy evaluation showed an improvement from 2 weeks after the SFPP application, which continued during the 52 weeks’ treatment. Conclusions No apparent safety concerns were observed, even during the long-term SFPP application. Therefore, SFPP could be an additional pharmacotherapy in OA treatment.
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Affiliation(s)
- Ikuko Yataba
- Development Headquarters, Taisho Pharmaceutical Co., Ltd., 3-24-1 Takada, Toshima-ku, Tokyo, 170-8633, Japan
| | - Noboru Otsuka
- Development Headquarters, Taisho Pharmaceutical Co., Ltd., 3-24-1 Takada, Toshima-ku, Tokyo, 170-8633, Japan.
| | - Isao Matsushita
- Development Headquarters, Taisho Pharmaceutical Co., Ltd., 3-24-1 Takada, Toshima-ku, Tokyo, 170-8633, Japan
| | - Hideo Matsumoto
- Institute for Integrated Sports Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Yuichi Hoshino
- Orthopedic Surgery, School of Medicine, Jichi Medical University, Tochigi, Japan
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