7 New Findings on Aspirin and NSAID Use

CALCULATING NSAID RISK.  Toxicity among NSAID users is a real concern among healthcare providers. So, coming up with a solid risk-benefit ratio formula could help keep patients safe. In this study, published in February in Arthritis & Rheumatology, researchers came up with a risk score for major toxicity. Data was collected from 23,735 NSAID users who were enrolled in controlled trials. The group included rheumatoid arthritis and osteoarthritis patients with cardiovascular disease or cardiovascular risk factors. They were randomized to celecoxib, naproxen or ibuprofen. Adverse events included major adverse cardiovascular events, acute kidney injury, significant gastrointestinal events, and mortality. 16,273 (68.6%) had a predicted one-year risk of 1‐4%; 6,382 (26.9%) had a one-year predicted risk of greater than 4%; and, 1,080 patients (4.6%) were found to have a  one‐year risk of less than 1%. (©BrianYarvin, AdobeStock)

ASPIRIN REDUCES CANCER RISK.  A Taiwanese study published in the JAMA Internal Medicine in March shows that taking aspirin daily may reduce the risk of hepatitis B virus-related hepatocellular carcinoma. The study included 10,615 patients (72.4% men) with chronic hepatitis B virus. 98% took 100 mg daily or less for three years. The cumulative incidence of hepatocellular carcinoma in patients who took aspirin was significantly lower than that of patients who did not take aspirin over 5 years (5.20%; 95% CI, 4.11%-6.29% vs 7.87%; 95% CI, 7.15%-8.60%; P < .001). (©Photographee.eu,Shutterstock)

ASPIRIN REDUCES MAJOR ADVERSE CARDIOVASCULAR EVENTS.  A  study in the May 5 issue of the Journal of Clinical Medicine finds that low-dose aspirin could serve as a primary prevention strategy for cardiovascular disease in diabetes patients, particularly in patients 60 years and older. The findings are based on a review of studies from three key databases. It ultimately included 29,814 patients. Patients who took dose aspirin (81 or 100 mg/day) experienced a 9% reduction in major adverse cardiovascular events, but increased the risk of major hemorrhage by 24%. (©AdobeStock_Kaliantye)

NSAIDs NOT ALWAYS THE PREFERRED TREATMENT.  There are a number of treatments for osteoarthritis and some are better than others. Researchers writing in the April 9 issue of the journal BMC Musculoskeletal Disorders reviewed 34 studies that investigated treatments for knee osteoarthritis. They examined the safety of moderate exercise, weight loss, paracetamol, glucosamine, intraarticular hyaluronic acid and platelet-rich-plasma injections, all of which were associated with low risk and benefits that lasted at least 12 months. However, although NSAIDs served as an effective pain reliever, they were associated with an increased risk of medical complications as were cortisone injections which contributed to the degeneration of radiological cartilage beyond 12 months. Arthroscopy, a minimally invasive surgical repair for degenerative meniscal tears, was found to increase the chances of having total knee arthroplasty (TKA) by three times, but TKA is associated with significant medical complications but "is justified by the efficacy of joint replacement in late-stage disease."  (©Alexlmx, AdobeStock)

ANTI-INFLAMMATORY DRUGS FOR DEPRESSION? a review of 36 clinical trials of anti-inflammatory drugs and its effect on pharmaceutical treatments for major depressive disorder or depressive symptoms, shows that anti-inflammatory drugs may have an ameliorating effect on depression. The study, published March 4 in the journal Acta Psychiatrica Scandinavica, included studies that investigated NSAIDS, cytokine inhibitors, statins, minocycline, pioglitazone glucocorticoids. “Anti‐inflammatory agents improved depressive symptoms compared to placebo as add‐on in patients with major depressive disorder and as monotherapy. Anti‐inflammatory add‐on improved response and remission.” Of note, investigators found an increased risk for infections. (©LightpoetShutterstock.com)

NSAIDs WORK, BUT WANE AFTER TWO WEEKS.  A systematic review and meta‐analyses published in March in Arthritis Care and Research, finds that NSAIDs effectively control pain in osteoarthritis, but only for the first two weeks. The analysis, of 72 studies, shows that the analgesic effect wanes after two weeks. And, gastrointestinal adverse events, although minor, begin to show at about four weeks. "Clinicians should weigh the durability of efficacy with the early onset of minor adverse events along with patient tolerability and preferences when formulating an NSAID regimen." (©Naftizin, AdobeStock)

HOW LONG IS TOO LONG FOR NSAIDs USE?  NSAIDs 45% of orthopedic patients who visited a single clinic in Saudi Arabia over the course of one year, say they took NSAIDs daily for seven years on average, according to a cross-sectional study published in the April-June journal of the Saudi Journal of Anaesthesia. Of note, it is generally accepted that patients not take over-the-counter NSAIDs for more than 10 days to avoid adverse events. And, only 21% took NSAIDs with food as recommended. More than one-third of atients surveyed said that they were underinformed about risks associated with NSAIDs. Most said they would discontinue NSAIDs, if they understood the risks.  (©Photographee.eu, AdobeStock)