Non steroidal topical immunomodulators

Formulations of topical diclofenac, ibuprofen, ketoprofen, piroxicam, and indomethacin demonstrated significantly higher rates of clinical success (more participants with at least 50% pain relief) than matching topical placebo (moderate or high quality data ). Benzydamine did not. Three drug and formulation combinations had NNTs for clinical success below 4. For diclofenac, the Emulgel® formulation had the lowest NNT of (95% CI to ) in two studies using at least 50% pain intensity reduction as the outcome . Diclofenac plasters other than Flector® also had a low NNT of ( to ) based on good or excellent responses in some studies. Ketoprofen gel had an NNT of ( to ), from five studies in the 1980s, some with less well defined outcomes. Ibuprofen gel had an NNT of ( to ) from two studies with outcomes of marked improvement or complete remission. All other drug and formulation combinations had NNT values above 4, indicating lesser efficacy .

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  • Citation tools Download this article to citation manager Arfè Andrea , Scotti Lorenza , Varas-Lorenzo Cristina , Nicotra Federica , Zambon Antonella , Kollhorst Bianca et al. Non-steroidal anti-inflammatory drugs and risk of heart failure in four European countries: nested case-control study BMJ 2016; 354 :i4857
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    While topical administration of NSAIDs achieves therapeutic levels in the aqueous humor, thereby reducing the synthesis of PGs in the ciliary body and the iris, such a therapeutic effect is less evident in the retina and the choroid. Few studies have measured NSAID levels in the human vitreous cavity after topical administration. Heier et al. [ 42 ]. measured vitreous drug levels in patients who received ketorolac % QID, bromfenac % BID, or nepafenac % TID for 3 days before vitrectomy. Vitreous levels of ketorolac, bromfenac, and amfenac were reportedly  ng/mL,  ng/mL, and  ng/mL, respectively, but only ketorolac resulted in significantly lower vitreous PGE 2 levels compared to placebo.

    Non steroidal topical immunomodulators

    non steroidal topical immunomodulators


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