Document Detail


An evidence-based approach to prescribing NSAIDs in musculoskeletal disease: a Canadian consensus. Canadian NSAID Consensus Participants.
MedLine Citation:
PMID:  8673987     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To make recommendations for the long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) in primary care practice, particularly for patients at high risk for NSAID-induced complications. OPTIONS: The use of misoprostol to prevent gastrointestinal ulceration and other unwanted NSAIDs effects was considered. The role of cyclooxygenase-2 (COX-2) versus COX-1 inhibiting agents was also examined. OUTCOMES: Reduction of complications associated with long-term use of NSAIDs. EVIDENCE: Evidence was gathered in late 1995 from published research studies and reviews. Position papers were prepared by faculty and advisory board members and discussed at the Canadian NSAID Consensus Symposium in Cambridge, Ont., Jan. 26 and 27, 1996. VALUES: Recommendations were based on randomized, placebo-controlled clinical trials (level I evidence) and case-control studies (level II evidence) involving NSAID use when such evidence was available. When the scientific literature was incomplete or inconsistent in a particular area, recommendations reflect the consensus of the participants at the symposium (level III evidence). Physicians were recruited from across Canada for their expertise in rheumatology, gastroenterology, epidemiology, gerontology, family practice, and clinical and basic scientific research. BENEFITS, HARMS AND COSTS: Although a reduction in complications due to inappropriate NSAID use should reduce costs of additional investigations, admissions to hospital and time lost from work, definitive cost analysis studies are not yet available. RECOMMENDATIONS: Currently, no NSAID is available that lacks potential for serious toxicity; therefore, long-term use of NSAIDs should be avoided whenever possible, particularly in high-risk patients (e.g., those who are elderly, suffer from hypertension, congestive heart failure, renal or hepatic impairment or volume depletion, take certain concomitant medications or have a history of peptic ulcer disease) (level I evidence). If NSAIDs are to be used in patients with gastric or nephrotoxic risk factors, the lowest effective dose of NSAID should be used (level III evidence); NSAIDs that are weak COX-1 inhibitors may be preferred (level II evidence). In addition, concomitant administration of misoprostol is recommended in patients at increased risk for upper gastrointestinal complications (level I evidence). However, the clinical judgement of the practising clinician must always be part of any therapeutic decision. VALIDATION: These recommendations are based on the consensus of Canadian experts in rheumatology, gastroenterology and epidemiology, and have been subjected to external peer review.
Authors:
H Tannenbaum; P Davis; A S Russell; M H Atkinson; W Maksymowych; S H Huang; M Bell; G A Hawker; A Juby; S Vanner; J Sibley
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Publication Detail:
Type:  Consensus Development Conference; Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne     Volume:  155     ISSN:  0820-3946     ISO Abbreviation:  CMAJ     Publication Date:  1996 Jul 
Date Detail:
Created Date:  1996-08-09     Completed Date:  1996-08-09     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  9711805     Medline TA:  CMAJ     Country:  CANADA    
Other Details:
Languages:  eng     Pagination:  77-88     Citation Subset:  AIM; IM    
Affiliation:
Rheumatic Disease Centre of Montreal, QC.
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MeSH Terms
Descriptor/Qualifier:
Anti-Inflammatory Agents, Non-Steroidal / adverse effects*,  therapeutic use
Canada
Drug Interactions
Humans
Kidney / drug effects
Musculoskeletal Diseases / drug therapy*
Peptic Ulcer / chemically induced,  prevention & control
Chemical
Reg. No./Substance:
0/Anti-Inflammatory Agents, Non-Steroidal
Comments/Corrections
Comment In:
CMAJ. 1996 Oct 15;155(8):1043   [PMID:  8873631 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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