PMID- 32821151
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200928
IS  - 1178-7090 (Print)
IS  - 1178-7090 (Electronic)
IS  - 1178-7090 (Linking)
VI  - 13
DP  - 2020
TI  - Practice Advisory on the Appropriate Use of NSAIDs in Primary Care.
PG  - 1925-1939
LID - 10.2147/JPR.S247781 [doi]
AB  - Cyclo-oxygenase (COX)-2 selective and nonselective nonsteroidal anti-inflammatory 
      drugs (NSAIDs) are important in managing acute and chronic pain secondary to 
      inflammation. As a greater understanding of the risks of gastrointestinal (GI), 
      cardiovascular (CV) and renal events with NSAIDs use has emerged, guidelines have 
      evolved to reflect differences in risks among NSAIDs. Updated guidelines have yet 
      to reflect new evidence from recent trials which showed similar CV event rates 
      with celecoxib compared to naproxen and ibuprofen, and significantly better GI 
      tolerability for celecoxib. This practice advisory paper aims to present 
      consensus statements and associated guidance regarding appropriate NSAID use 
      based on a review of current evidence by a multidisciplinary group of expert 
      clinicians. This paper is especially intended to guide primary care practitioners 
      within Asia in the appropriate use of NSAIDs in primary care. Following a 
      literature review, group members used a modified Delphi consensus process to 
      determine agreement with selected recommendations. Agreement with a statement by 
      75% of total voting members was defined a priori as consensus. For low GI risk 
      patients, any nonselective NSAID plus proton pump inhibitor (PPI) or celecoxib 
      alone is acceptable treatment when CV risk is low; for high CV risk patients, 
      low-dose celecoxib or naproxen plus PPI is appropriate. For high GI risk 
      patients, celecoxib plus PPI is acceptable for low CV risk patients; low-dose 
      celecoxib plus PPI is appropriate for high CV risk patients, with the alternative 
      to avoid NSAIDs and consider opioids instead. Appropriate NSAID prescription 
      assumes that the patient has normal renal function at commencement, with ongoing 
      monitoring recommended. In conclusion, appropriate NSAID use requires 
      consideration of all risks.
CI  - (c) 2020 Ho et al.
FAU - Ho, Kok Yuen
AU  - Ho KY
AUID- ORCID: 0000-0001-9466-0242
AD  - The Pain Clinic, Mt Alvernia Hospital, Singapore.
FAU - Cardosa, Mary S
AU  - Cardosa MS
AUID- ORCID: 0000-0001-9788-3978
AD  - Selayang Hospital, Batu Caves, Selangor, Malaysia.
FAU - Chaiamnuay, Sumapa
AU  - Chaiamnuay S
AUID- ORCID: 0000-0001-6056-3559
AD  - Rheumatic Disease Unit, Phramongkutklao Hospital and College of Medicine, 
      Bangkok, Thailand.
FAU - Hidayat, Rudy
AU  - Hidayat R
AUID- ORCID: 0000-0003-4895-2409
AD  - Rheumatology Division, Department of Internal Medicine, Faculty of Medicine, 
      Universitas Indonesia, Cipto Mangunkusomo Hospital, Jakarta, Indonesia.
FAU - Ho, Huynh Quang Tri
AU  - Ho HQT
AD  - Heart Institute, Ho Chi Minh City, Vietnam.
FAU - Kamil, Ozlan
AU  - Kamil O
AUID- ORCID: 0000-0001-5982-5451
AD  - Gleneagles Hospital, Kuala Lumpur, Malaysia.
AD  - Prince Court Medical Center, Kuala Lumpur, Malaysia.
FAU - Mokhtar, Sabarul A
AU  - Mokhtar SA
AUID- ORCID: 0000-0002-4450-2489
AD  - Department of Orthopaedics and Traumatology, Faculty of Medicine, Universiti 
      Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
FAU - Nakata, Ken
AU  - Nakata K
AUID- ORCID: 0000-0002-8964-4229
AD  - Department of Health and Sport Sciences, Osaka University Graduate School of 
      Medicine, Osaka, Japan.
FAU - Navarra, Sandra V
AU  - Navarra SV
AD  - Section of Rheumatology, Department of Medicine, University of Santo Tomas, 
      Manila, Philippines.
FAU - Nguyen, Van Hung
AU  - Nguyen VH
AD  - Department of Rheumatology, Bach Mai Hospital, Hanoi, Vietnam.
FAU - Pinzon, Rizaldy
AU  - Pinzon R
AUID- ORCID: 0000-0002-3357-9907
AD  - Department of Neurology, Faculty of Medicine, Kristen Duta Wacana University, 
      Bethesda Hospital, Yogyakarta, Indonesia.
FAU - Tsuruoka, Shuichi
AU  - Tsuruoka S
AUID- ORCID: 0000-0002-2918-4435
AD  - Department of Nephrology, Nippon Medical School, Tokyo, Japan.
FAU - Yim, Heng Boon
AU  - Yim HB
AUID- ORCID: 0000-0003-1219-9734
AD  - Mount Elizabeth Novena Hospital, Singapore.
AD  - Faculty of Medicine, National University of Singapore, Singapore.
FAU - Choy, Ernest
AU  - Choy E
AUID- ORCID: 0000-0003-4459-8609
AD  - Institute of Infection and Immunity, Cardiff University School of Medicine, 
      Cardiff, UK.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20200803
PL  - New Zealand
TA  - J Pain Res
JT  - Journal of pain research
JID - 101540514
PMC - PMC7422842
OTO - NOTNLM
OT  - COX-2 selective inhibitors
OT  - cardiovascular risk
OT  - gastrointestinal risk
OT  - inflammation
OT  - nonsteroidal anti-inflammatory drugs
OT  - osteoarthritis
COIS- The meeting during which these recommendations were initially discussed was 
      organized and funded by Pfizer. Pfizer representatives did not participate in 
      discussions. KY Ho has received honoraria from Pfizer, Mundipharma, P&G, Avanos 
      and A. Menarini, and reports non-financial support from MIMS HK (manuscript 
      preparation) and personal fees from Pfizer for attending expert meeting during 
      the conduct of the study, and personal fees from Menarini, Baxter Healthcare, 
      Mundipharma, Johnson & Johnson, and Avanos, outside the submitted work. M Cardosa 
      has received honoraria for giving lectures and participating in expert group 
      discussions for Pfizer, Mundipharma, A. Menarini and GlaxoSmithKline and reports 
      that IASP received Pfizer Independent Grants for Learning and Change (IGLC) grant 
      in 2017 for the project "A Toolkit for Multidisciplinary Pain Clinics in 
      Southeast Asia". S Chaiamnuay has received honoraria from Pfizer, Amgen, 
      Janssen-Cilag, Astellas and Novartis.HQT Ho has received honoraria from Pfizer, 
      A. Menarini, Merck and Boehringer-Ingelheim. O Kamil has served on advisory 
      boards for Amgen and Pfizer, and has received honoraria from Amgen, Pfizer, MIMS, 
      Johnson & Johnson and Merck Sharp & Dohme. S Mokhtar has received honoraria from 
      Pfizer, Lilly and Amgen. S Navarra has received honoraria from Pfizer, Abbott, 
      Johnson & Johnson and Novartis. R Pinzon has received honoraria from Pfizer, P&G 
      and Soho Pharma. S Tsuruoka has received honoraria from Pfizer, Astellas, 
      AstraZeneca, Teijin Pharma and Tanabe-Mitsubishi Pharma. HB Yim served as a 
      principal investigator for the CONDOR trial and has served on advisory boards and 
      received honoraria from Takeda. E Choy has received research grants and/or 
      personal fees from, and/or served as member of advisory boards and speaker 
      bureaus of, AbbVie, Allergan, Amgen, AstraZeneca, Bio-Cancer, Biogen, 
      Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Chugai Pharma, Daiichi 
      Sankyo, Eli Lilly, Ferring Pharmaceutical, Gilead, GlaxoSmithKline, Hospira, 
      ISIS, Jazz Pharmaceuticals, Janssen, MedImmune, Merrimack Pharmaceutical, Merck 
      Sharp & Dohme, Napp, Novimmune, Novartis, ObsEva, Pfizer, Regeneron, Roche, 
      R-Pharm, Sanofi, SynAct Pharma, Synovate, Tonix and UCB. All other authors report 
      no conflicts of interest in this work.
EDAT- 2020/08/22 06:00
MHDA- 2020/08/22 06:01
PMCR- 2020/08/03
CRDT- 2020/08/22 06:00
PHST- 2020/01/30 00:00 [received]
PHST- 2020/06/24 00:00 [accepted]
PHST- 2020/08/22 06:00 [entrez]
PHST- 2020/08/22 06:00 [pubmed]
PHST- 2020/08/22 06:01 [medline]
PHST- 2020/08/03 00:00 [pmc-release]
AID - 247781 [pii]
AID - 10.2147/JPR.S247781 [doi]
PST - epublish
SO  - J Pain Res. 2020 Aug 3;13:1925-1939. doi: 10.2147/JPR.S247781. eCollection 2020.