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Drug Class Review: Nonsteroidal Antiinflammatory Drugs (NSAIDs): Final Update 4 Report [Internet]

Drug Class Review: Nonsteroidal Antiinflammatory Drugs (NSAIDs): Final Update 4 Report [Internet]

Drug Class Reviews - Oregon Health & Science University

Version: November 2010


Compared with placebo, nonsteroidal antiinflammatory drugs (commonly called NSAIDs) reduce pain significantly in patients with arthritis, low back pain, and soft tissue pain. However, NSAIDs have important adverse effects, including gastrointestinal bleeding, peptic ulcer disease, hypertension, edema, and renal disease. More recently, some NSAIDs have also been associated with an increased risk of myocardial infarction.


Chronic pain from osteoarthritis


A total of 2941 (1139 from update 4) records were identified from searching electronic databases, reviews of reference lists, pharmaceutical manufacturer dossier submissions, and public comments. By applying the eligibility and exclusion criteria, we ultimately included 159 publications (33 for Update 4). Of these, 68 were trials (23 for Update 4), 47 were observational studies (4 for Update 4), 32 were systematic reviews (4 for Update 4), and 12 were pooled analyses and post-hoc analyses (2 for Update 4). See Appendix E for a list of excluded studies and reasons for exclusion at full text. Figure 1 shows the flow of study selection for Update 4.


The main findings of this review are summarized in Table 6 below. Little evidence on the comparative effectiveness of NSAIDs was truly effectiveness or “real world” – while some trials evaluated longer-term (>6-12 months) and real life (symptoms, clinical ulcers, functional status, myocardial infarctions, pain relief) outcomes, none were conducted in primary care or office-based setting or used broad enrollment criteria.

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