Excerpt

The purpose of this report was to assess the comparative efficacy and safety of non-opioid oral medications (selective and non-selective non-aspirin NSAIDs, aspirin, salsalate, and acetaminophen), over-the-counter supplements (chondroitin and glucosamine), and topical agents (NSAIDs and rubefacients, including capsaicin) for osteoarthritis.

Contents

• Preface
• Acknowledgments
• Executive Summary
• 1. Introduction
  • Scope and Key Questions
• 2. Methods
  • Topic Development
  • Search Strategy
  • Study Selection
  • Data Extraction
  • Quality Assessment
  • Data Synthesis
• 3. Results
  • Overview
  • Key Question 1a. What are the comparative benefits and harms of treating osteoarthritis with oral medications or supplements?
  • Key Question 1b. How do these benefits and harms change with dosage and duration of treatment, and what is the evidence that alternative dosage strategies, such as intermittent dosing and drug holidays, affect the benefits and harms of oral medication use?
  • Key Question 2. Do the comparative benefits and harms of oral treatments for osteoarthritis vary for certain demographic and clinical subgroups?
  • Key Question 3. What are the comparative effects of co-prescribing of H2-antagonists, misoprostol, or proton pump inhibitors (PPIs) on the gastrointestinal harms associated with NSAID use?
  • Key Question 4. What are the comparative benefits and harms of treating osteoarthritis with oral medications as compared with topical preparations?
• 4. Summary and Discussion
  • Discussion
• 5. Future Research
• 6. Addendum
• References
• Appendixes
  • Appendix A Pharmacokinetics, Indications and Dosing of Included Drugs
  • Appendix B Cyclooxygenase Selectivity of NSAIDs
  • Appendix C Comparable NSAID Dose Levels
  • Appendix D Exact Search Strings
  • Appendix E Quality Assessment Methods
  • Appendix F Evidence Tables

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.¹ Contract No. 290-02-0024. Prepared by: Oregon Evidence-based Practice Center.

Suggested citation:

Chou R, Helfand M, Peterson K, Dana T, Roberts C. Comparative Effectiveness and Safety of Analgesics for Osteoarthritis. Comparative Effectiveness Review No. 4. (Prepared by the Oregon Evidence-based Practice Center under Contract No. 290-02-0024.) Rockville, MD: Agency for Healthcare Research and Quality. September 2006. Available at: www.effectivehealthcare.ahrq.gov/reports/final.cfm.

None of the investigators has any affiliations or financial involvement that conflicts with the material presented in this report.

This report is based on research conducted by the Oregon Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-02-0024). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this article should be construed as an official position of the Agency for Healthcare Research and Quality or of the U.S. Department of Health and Human Services.

This report is intended as a reference and not as a substitute for clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information.

This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

1

540 Gaither Road, Rockville, MD 20850. www​.ahrq.gov