Patient and physician satisfaction with aceclofenac: results of the European Observational Cohort Study (experience with aceclofenac for inflammatory pain in daily practice). Aceclofenac is the treatment of choice for patients and physicians in the management of inflammatory pain

Safety and effectiveness of 4-week therapy with aceclofenac controlled release once a day

Aceclofenac controlled-release (CR) is a once-a-day tablet with 200 mg of aceclofenac, and is bioequivalent to conventional aceclofenac. However, its safety in humans has not been well studied in Korea. Therefore, we aimed to evaluate the overall incidence and patterns of adverse events (AEs), the effectiveness of aceclofenac CR, and the differences in incidence rates of the AEs based on each patient’s baseline charateristics. This study was conducted on patients receiving aceclofenac CR in clinical practice at each investigational institution to treat musculoskeletal pain and inflammation. The subjects were administered one tablet of aceclofenac CR (200 mg once-a-day) and were observed for 4 weeks post-administration. Factors affecting the occurrence of AEs were evaluated, and the Visual Analogue Scale (VAS) was used to measure the pain intensity. Among 14,543 subjects, the incidence rate of AEs was 0.86%, and that of adverse drug reactions was 0.74%. No serious AEs and unexpected adverse drug reactions were monitored. The incidence rates of AEs were significantly higher in females, inpatient treatment, individuals with concurrent disorders, and those receiving concomitant medications, respectively (all P < 0.05). Four weeks post-using aceclofenac CR, the mean changes in VAS was significantly decreased compared to prior administration. The overall clinical efficacy rate was 91.63%. This study confirmed that no severe adverse reactions were observed for aceclofenac CR exceeding those previously reported for safety results of conventional formulation of this drug in routine clinical practice settings. The use of aceclofenac CR might not violate the previously reported information on the safety and effectiveness of aceclofenac.

[Assessment of the safety, tolerability and effectiveness of first Russian generic aceclofenac in patients with undifferentiated peripheral inflammatory arthritis]

AIM

To evaluate the effectiveness and tolerability of the drug in patients with undifferentiated peripheral inflammatory arthritis (UPIA).

MATERIALS AND METHODS

We observed 60 patients (39 women and 21 men) met G. Hazlewood et al., UPIA criteria, 2011. Patients were divided into 3 groups: with monoarthritis, oligoarthritis and polyarthritis. They took aceclofenac 100 mg twice day for 3 weeks.

RESULTS

We noted significant decreasing in pain level according to visual analogue scale: in patients with monoarthritis by 69.3 mm (p0.001); in oligoarthritis group by 47.5 mm (p0.001), in patients with polyarthritis by 30 mm (p0.001). The life quality by the EQ-5D-5L index was improved too in all groups from 0.616 to 0.829 (p0.001). The satisfaction with the therapy was: in monoarthritis patients (80% of patients and 93% of doctors noted good results), in oligoarthritis group (53% and 39% accordingly) and polyarthritis (74% and 64% respectively). We suppose the difference was due to the fact that mono- and oligoarthritis patients suffered from initial forms of seronegative spondylarthropathy, in which the effectiveness of NSAIDs is traditionally higher; polyarthritis patients probably had debut of rheumatoid arthritis. Adverse events of therapy were mild. We noted gastrointestinal tract symptoms (dyspepsia) and increased ALT in 10 patients and increased blood pressure in 1 patient. The symptoms did not require discontinuation of therapy. Сonclusion. Post-registration observational study of first Russian generic aceclofenac (Alental, Vertex, Russia) was conducted. In UPIA patients aceclofenac therapy was most effective in mono- and oligoarthritis patients. The first Russian generic aceclofenac (Alental, Vertex, Russia) has good efficacy, tolerability and safety and can be recommended for arthritis treatment.

Efficacy and safety of aceclofenac in osteoarthritis: A meta-analysis of randomized controlled trials

OBJECTIVE

To analyze the effects on pain, function, and safety of aceclofenac compared with other nonsteroidal anti-inflammatory drugs (NSAIDs) or pain relief medications in patients with osteoarthritis.

MATERIAL AND METHODS

Two investigators independently searched the database. We included randomized controlled trials evaluating efficacy and/or safety of aceclofenac compared with control interventions (NSAIDs or acetaminophen) in patients with osteoarthritis. We did not include placebo, opioid analgesics, NSAID combinations, and topical analgesics for the control groups. We summarized the efficacy data as standardized mean differences (SMD) with 95% confidence intervals (CI) and safety outcomes as risk ratios (RR) with 95% CI using the inverse variance random effect model. We assessed the heterogeneity by the I² test. We used the GRADE approach to evaluate the quality of the evidence for all outcome parameters.

RESULTS

We included 9 trials (8 double blind and 1 single blind) that evaluated pain (7 trials), function (8 trials) and safety (7 trials). We observed no significant difference in pain reduction between aceclofenac and control interventions [SMD: -0.30 (-0.62, 0.01); I²=88%; GRADE evidence- low]. Aceclofenac was more beneficial than control interventions in improving physical function [SMD: -0.27 (-0.50, -0.03); I²=88%; GRADE evidence- low]. We observed less gastrointestinal adverse events for aceclofenac than in control interventions [RR 0.69 (95% CI: 0.57, 0.83); I²=12%; GRADE evidence- moderate]. We observed no difference in overall adverse events occurrence and dropout rate between aceclofenac and control interventions.

CONCLUSION

We observed that aceclofenac was beneficial over control analgesics for function improvement and to minimize gastrointestinal adverse events. Our findings could be biased due to the heterogeneity of the sample, the fact that the trials were small and methodological issues.

Epidemiology of chronic non-cancer pain in Europe: narrative review of prevalence, pain treatments and pain impact

BACKGROUND

Estimates on the epidemiology of chronic non-cancer pain vary widely throughout Europe. It is unclear whether this variation reflects true population differences or methodological factors. Such epidemiological information supports European decision makers in allocating healthcare resources.

OBJECTIVE

Pan-Europe epidemiological data about chronic non-cancer pain was obtained using systematic review principles in searching and summarising results.

METHODS

Multiple databases (MEDLINE, EMBASE, Cochrane Library, CRD Databases, and GIN) were systematically searched for primary studies containing epidemiological data on chronic non-cancer pain in Europe excluding studies that solely concerned migraines, headaches and pain associated with specific disease conditions. The studies were prioritised according to quality, recency and validity.

MAIN OUTCOMES

Eighteen research questions concerning aspects of chronic pain included: prevalence; incidence; pain treatments, control and compliance; treatment satisfaction; and quality of life and economic impacts.

RESULTS

The search yielded 16 619 references and 45 were relevant to Europe. Studies for each question were selected that provided the most recent, representative and valid data. There was a clear lack of studies concerning chronic non-cancer pain in Europe as a whole. The 1-month prevalence of moderate-to-severe non-cancer chronic pain was 19%. Chronic pain significantly impacted on patient-perceived health status, affected everyday activities including economic pursuits and personal relationships, and was significantly associated with depressive symptoms. The majority relied on drugs for pain control and NSAIDs were the most frequent drug choice. Despite pain medications, a large proportion had inadequate pain control.

CONCLUSION

To the authors' knowledge this is the most comprehensive literature review on epidemiological data in this field. It is clear that chronic pain has a dramatic impact on European society. Since chronic non-cancer pain is treated differently from cancer-related pain, the lack of data in this area clearly underlines the need for decision makers in healthcare to gather further epidemiological data.

Pain and osteoarthritis: new drugs and mechanisms

PURPOSE OF REVIEW

This review discusses the recent literature on drugs used for symptomatic pain relief in patients with osteoarthritis (OA) as well as potential mechanisms underlying their pharmacologic action.

RECENT FINDINGS

Recent research has shed light on the molecular mechanisms underlying the contribution of prostaglandins to pain sensation. Moreover, the role of the enzymes cyclooxygenase-2 (COX-2) and 5-lipoxygenase (5-LOX) in inflammation and subsequent structural changes of joints has been clarified. Based on the COX-1/COX-2 hypothesis, various selective COX-2 inhibitors with improved gastrointestinal tolerability as compared with conventional nonsteroidal anti-inflammatory drugs (NSAIDs) have been established for the symptomatic treatment of OA in recent years. Rational therapy with these compounds should be based on their diverse pharmacokinetic characteristics. Among the traditional NSAIDs, the mode of action of aceclofenac has been recently clarified in that the compound was shown to elicit preferential inhibition of COX-2 as a result of limited but sustained biotransformation to diclofenac. Novel mechanisms have also been proposed to account for the action of acetaminophen. Finally, there is evidence from animal models to suggest that the dual LOX/COX inhibitor licofelone may stop disease progression in OA. Clinical studies are under way to establish this compound for treatment of OA.

SUMMARY

It is anticipated that new insights into the pathophysiology of OA as well as novel therapeutics will improve the pharmacologic options in OA.

Aceclofenac in the management of inflammatory pain

Aceclofenac (Almirall Prodesfarma SA) is an oral NSAID that is effective in the treatment of painful inflammatory diseases and has been used to treat > 75 million patients worldwide. It has proved as effective as diclofenac, naproxen and piroxicam in patients with osteoarthritis, diclofenac, ketorolac, tenoxicam and indomethacin in patients with rheumatoid arthritis and tenoxicam, naproxen and indomethacin in patients with ankylosing spondylitis. It also provides effective analgesia in other indications, such as dental or gynaecological pain, lower back pain and ear, nose and throat indications. Aceclofenac appears to be particularly well-tolerated amongst the NSAIDs, with a lower incidence of gastrointestinal adverse effects. This good tolerability profile results in a reduced withdrawal rate and hence greater compliance with treatment.