Pain Tx in the News
Pain Tx in the News
FDA approves Xeljanz for RA ... Cochrane review affirms efficacy of topical NSAIDs for musculoskeletal pain
November 20, 2012
Latest news in the treatment of chronic pain.
FDA approves new treatment option for RA
The FDA approved tofacitinib citrate (Xeljanz; Pfizer) on November 6 for the treatment of moderate to severe active rheumatoid arthritis (RA). Tofacitinib is approved for use in adults with RA who have not responded adequately to methotrexate.
The recommended dose is 5 mg PO twice daily. Tofacitinib may be used as monotherapy for RA; it may also be combined with methotrexate or with other nonbiologic disease-modifying antirheumatic drugs (DMARDs). It should
be used in combination with biologic DMARDs or with immunosuppressants such as azathioprine and cyclosporine.
Tofacitinib works by blocking Janus kinase (JAK) molecules, which are important in the joint inflammation of RA. It is the first drug of this class to target RA.
for tofacitinib includes a boxed warning of the drug’s safety risks, which include serious bacterial, invasive fungal, viral, and other opportunistic infections; tuberculosis; lymphoma; and other malignancies.
Higher cholesterol levels, increased liver enzyme levels, and decreased blood cell counts have been seen in patients taking tofacitinib.
In clinical trials, the most common adverse reactions to tofacitinib were upper respiratory infections, headache, diarrhea, and nasopharyngitis.
A postmarketing study will be conducted to evaluate the long-term effects of tofacitinib on cardiac disease, cancer, and serious infections.
Cochrane analysis: Topical NSAIDs effective for chronic musculoskeletal pain
A recent Cochrane review affirms that topical nonsteroidal anti-inflammatory drugs (NSAIDs) are effective for chronic musculoskeletal pain in adults.
Sheena Derry, PhD, of the University of Oxford’s Pain Research and Nuffield Department of Clinical Neurosciences, Oxford, UK, and associates searched electronic databases, clinical trial registers, and topical NSAID manufacturers’ databases for high-quality studies of topical NSAIDs used to treat chronic musculoskeletal pain. They looked at randomized, double-blind studies that included placebo or active comparators where at least one treatment was a topical NSAID formulation (cream, gel, patch, solution). They looked at studies that were at least 8 weeks long.
After analyzing data from 34 studies that included 7688 participants, Derry and colleagues found that:
Topical NSAIDs were significantly more effective than placebo in reducing chronic musculoskeletal pain.
The number-needed-to-treat (NNT) to achieve at least 50% pain relief for osteoarthritis over an 8- to 12-week period was 6.4 for diclofenac solution and 11 for diclofenac gel.
No difference in efficacy was shown in a direct comparison of topical NSAIDs with oral NSAIDs.
Local adverse events, such as skin reactions, were increased with topical NSAIDs compared with placebo or oral formulations, but no increase in serious adverse events was seen.
Gastrointestinal adverse events with topical NSAIDs occurred at the same rate as with placebo, and less frequently than with oral NSAIDs.
For an abstract of the Cochrane review, go to:
Derry S, Moore RA, Rabbie R.
Cochrane Database Syst Rev.
Sept 12, 2012; issue 9
Guidance on opioid prescribing … Evidence on alternative therapies for IBS … Benefits of vitamin D for chronic pain
IBS class helps patients manage symptoms … FDA issues call to action against opioid epidemic … Program with CBT and exercise benefits seniors in pain
Ambulatory infusion system gets FDA clearance . . . New therapeutic option proves helpful for treatment-refractory RA . . . Implantable buprenorphine gets priority review
Potentially harmful pain relief supplement is being sold under new name . . . Crush-resistant Opana ER is available in 2 new strengths . . . FDA approves Zecuity, a sumatriptan patch for migraine treatment
Hydrocodone/acetaminophen tablets recalled . . . Analgesic use linked to hearing loss in women
Most Viewed Topics
Chronic pain/Central pain
Most Viewed Articles
Most Searched Terms
Frontline Medical Communications
, Parsippany, NJ, USA.
All rights reserved
. Unauthorized use prohibited.
The information provided on chronicpainperspectives.com is for educational purposes only. Use of this Web site is subject to the