PMID- 20833736 OWN - NLM STAT- MEDLINE DCOM- 20110623 LR - 20211020 IS - 1468-2060 (Electronic) IS - 0003-4967 (Print) IS - 0003-4967 (Linking) VI - 70 IP - 5 DP - 2011 May TI - The appropriate use of non-steroidal anti-inflammatory drugs in rheumatic disease: opinions of a multidisciplinary European expert panel. PG - 818-22 LID - 10.1136/ard.2010.128660 [doi] AB - INTRODUCTION: Given the safety issues of non-steroidal anti-inflammatory drugs (NSAID) and the robustness of guidelines, making treatment choices in daily clinical practice is increasingly difficult. This study aimed systematically to analyse the opinions of a multidisciplinary European expert panel on the appropriateness of different NSAID, with or without the use of a proton pump inhibitor (PPI), in individual patients with chronic rheumatic disease. METHODS: /Using the Research and Development/University of California at Los Angeles appropriateness method, the appropriateness of five (non-)selective NSAID with or without a PPI was assessed for 144 hypothetical patient profiles, ie, unique combinations of cardiovascular and gastrointestinal risk factors. Appropriateness statements were calculated for all indications. RESULTS: All options without PPI were considered appropriate in patients with no gastrointestinal/cardiovascular risk factors. Cyclooxygenase-2 selective inhibitors (C2SI) alone and non-selective NSAID plus PPI were preferred for patients with elevated gastrointestinal risk and low cardiovascular risk. Naproxen plus PPI was favoured in patients with high cardiovascular risk. For the combination of high gastrointestinal/high cardiovascular risk the use of any NSAID was discouraged; if needed, naproxen plus PPI or a C2SI plus PPI could be considered. DISCUSSION: The panel results may support treatment considerations at the level of individual patients, according to their gastrointestinal/cardiovascular risk profile. FAU - Burmester, Gerd AU - Burmester G AD - Department of Rheumatology and Clinical Immunology, Charite - University Medicine, Free University and Humboldt University Berlin, Chariteplatz 1 10117, Berlin, Germany. gerd.burmester@charite.de FAU - Lanas, Angel AU - Lanas A FAU - Biasucci, Luigi AU - Biasucci L FAU - Hermann, Matthias AU - Hermann M FAU - Lohmander, Stefan AU - Lohmander S FAU - Olivieri, Ignazio AU - Olivieri I FAU - Scarpignato, Carmelo AU - Scarpignato C FAU - Smolen, Josef AU - Smolen J FAU - Hawkey, Chris AU - Hawkey C FAU - Bajkowski, Adam AU - Bajkowski A FAU - Berenbaum, Francis AU - Berenbaum F FAU - Breedveld, Ferdinand AU - Breedveld F FAU - Dieleman, Peter AU - Dieleman P FAU - Dougados, Maxime AU - Dougados M FAU - MacDonald, Thomas AU - MacDonald T FAU - Mola, Emilio Martin AU - Mola EM FAU - Mets, Tony AU - Mets T FAU - Van den Noortgate, Nele AU - Van den Noortgate N FAU - Stoevelaar, Herman AU - Stoevelaar H LA - eng PT - Consensus Development Conference PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20100910 PL - England TA - Ann Rheum Dis JT - Annals of the rheumatic diseases JID - 0372355 RN - 0 (Anti-Inflammatory Agents, Non-Steroidal) RN - 0 (Proton Pump Inhibitors) SB - IM CIN - Nat Rev Rheumatol. 2011 Mar;7(3):133-4. PMID: 21263459 MH - Anti-Inflammatory Agents, Non-Steroidal/adverse effects/*therapeutic use MH - Cardiovascular Diseases/etiology/prevention & control MH - Chronic Disease MH - Gastrointestinal Diseases/chemically induced/prevention & control MH - Humans MH - Proton Pump Inhibitors/therapeutic use MH - Rheumatic Diseases/complications/*drug therapy MH - Risk Assessment/methods PMC - PMC3070276 COIS- Competing interests Panel members received honoraria from Pfizer for the rating activities and their participation in the panel meetings. GB has received fees for clinical trials from Pfizer and is a member of advisory boards and speakers bureau of Pfizer Germany and MSD Germany. AL has participated as a member of the steering committee of the CONDOR trial and as a speaker in symposiums sponsored by Pfizer. AL has also been advisor to AstraZeneca. LB has received fees for speeches and consultancy from Pfizer, Siemens diagnostic, Sanofi-Aventis and Merck. LB has also received a grant from Sanofi-Aventis. MH has received speaking fees from Pfizer and Novartis. SL has received honoraria as a member of advisory boards to Abbott, Boehringer, MerckSerono, NicOx, Pfizer, Sanofi-Aventis. IO received consulting fees, speaking fees and/or honoraria from Schering-Plough, Bristol-Myers Squibb, Pfizer-Wyett, Abbott, Merck Pharmaceutical, Novartis, Sanofi-Aventis and Roche. CS is on the speakers bureau of Pfizer, AstraZeneca and SIDEM Pharma. His laboratory has received research grants from Pfizer. JS has received honoraria for advisory board activities from Pfizer and Novartis. HS has received honoraria from Pfizer for advice to the design of the study and data analysis. TMM has received research grants from Novartis, Pfi zer, Ipsen & Menarini; principal investigator for Pfi zer, Novartis, Ipsen & Menarini; received consulting or speakers fees from Pfi zer, Novartis, Kaiser Permanente, Takeda, Recordati, Servier, Menarini, NiCox & AstraZeneca. CJH received research funding and/or honoraria from AstraZeneca, Atlantic Pharmaceuticals, Bayer, Logical Therapeutics, Novartis Pharma, Pfi zer and Reckitt Benckiser. FB received speaker honoraria from Abbott Laboratories. TM, PD, FB, EMM, AB, MD, NVDN: none apart from the general statement in the article: "Panel members received honoraria from Pfi zer for the rating activities and their participation in the panel meetings." EDAT- 2010/09/14 06:00 MHDA- 2011/06/24 06:00 PMCR- 2010/09/10 CRDT- 2010/09/14 06:00 PHST- 2010/09/14 06:00 [entrez] PHST- 2010/09/14 06:00 [pubmed] PHST- 2011/06/24 06:00 [medline] PHST- 2010/09/10 00:00 [pmc-release] AID - ard.2010.128660 [pii] AID - annrheumdis128660 [pii] AID - 10.1136/ard.2010.128660 [doi] PST - ppublish SO - Ann Rheum Dis. 2011 May;70(5):818-22. doi: 10.1136/ard.2010.128660. Epub 2010 Sep 10.