Duloxetine for kneee OA pain

JC: 31st August 2012

Age Ageing. 2012 Sep;41(5):646-52. Epub 2012 Jun 27.

Duloxetine for the management of pain in older adults with knee osteoarthritis: randomised placebo-controlled trial.

Abou-Raya S, Abou-Raya A, Helmii M.

Source

Geriatric Unit, Internal Medicine Department, University of Alexandria, Alexandria, Egypt.

Abstract

BACKGROUND:

pain is the leading symptom of osteoarthritis (OA) and is often chronic in nature, leading to significant morbidity and decreased quality of life. Duloxetine, a selective serotonin norepinephrine reuptake inhibitor has been demonstrated to have a centrally acting analgesic effect.

OBJECTIVES:

the aim of the present study was to investigate the efficacy of duloxetine in reducing pain in older adults with knee OA.

METHODS:

totally, 288 patients aged 65 years and above with primary knee OA were enrolled in this study. Patients were randomised 1:1. Totally, 144 received 60 mg/day of duloxetine HCL and 144 received placebo for 16 weeks. Outcome measures included pain reduction and improvement in physical functioning scores. Pain was assessed using the visual analogue pain scale (VAS; 0-100 mm). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were used to assess function.

RESULTS:

 two-hundred and seventy four of the 288 patients completed the study. There was a statistically significant reduction in pain and a significant improvement in WOMAC scores at 16 weeks in the duloxetine group versus the placebo group. No serious side effects were reported.

CONCLUSIONS:

the findings of the present study provide evidence for the efficacy and tolerability of duloxetine in reducing pain and subsequently improving function in older adults with knee OA. Trial Registration: NCT01425827.

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During the discussion, there was some skepticism about the resources that a university in Alexandria will have access to.....


 

Journal Club on 24th of August 2012

NEJM

Health Law, Ethics, and Human Rights

Ethical Considerations in Studying Drug Safety — The Institute of Medicine Report

Michelle M. Mello, J.D., Ph.D., Steven N. Goodman, M.D., M.H.S., Ph.D., and Ruth R. Faden, Ph.D., M.P.H.

August 22, 2012 (10.1056/NEJMhle1207160) 

Journal club on 17th August 2012

N Engl J Med. 2012 Aug 9;367(6):570-2.

Preclinical success against Alzheimer's disease with an old drug.

LaFerla FM.

Source

Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, USA.

PMID:

 

22873540

[PubMed - in process]

Journal club on 10th August 2012

Am Heart J. 2012 Apr;163(4):720-8. Epub 2012 Mar 14.

Safety and effectiveness of antithrombotic strategies in older adult patients with atrial fibrillation and non-ST elevation myocardial infarction.

Fosbol EL, Wang TY, Li S, Piccini JP, Lopes RD, Shah B, Mills RM, Klaskala W, Alexander KP, Thomas L, Roe MT, Peterson ED.

Source

Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27705, USA. emil.fosbol@duke.edu

Abstract

BACKGROUND:

We aimed to study the comparative safety and effectiveness of various antithrombotic treatment strategies among older adults with non-ST elevation myocardial infarction (NSTEMI) and atrial fibrillation (AF).

METHODS:

Using the CRUSADE registry linked to longitudinal Medicare claims data, we examined NSTEMI patients aged ≥ 65 years with a concomitant diagnosis of AF. Multivariable Cox analysis was used to compare risk of rehospitalization for bleeding and a major cardiac composite end point of death, readmission for myocardial infarction, or stroke, according to discharge antithrombotic strategy.

RESULTS:

Among 7619 NSTEMI patients with AF, 29% were discharged on aspirin alone; 37%, on aspirin + clopidogrel; 7%, on warfarin alone; 17%, on aspirin + warfarin; and 10%, on warfarin + aspirin + clopidogrel. There was no difference in predicted stroke risk between groups. By 1 year, 12.2% of patients were rehospitalized for bleeding, and 33.1% had a major cardiac event. Relative to aspirin alone, antithrombotic intensification was associated with increased bleeding risk (aspirin + clopidogrel adjusted HR 1.22, 95% CI 1.03-1.46 and warfarin + aspirin HR 1.46, 95% CI 1.21-1.80). Patients treated with aspirin + clopidogrel + warfarin had the highest observed bleeding risk (HR 1.65, 95% CI 1.30-2.10). One-year risk of the major cardiac end point was similar between groups, although, relative to aspirin only, there was a trend toward lower risk for the warfarin + aspirin group (HR 0.88, 95% CI 0.78-1.00).

CONCLUSIONS:

Older NSTEMI patients with AF are at high risk for subsequent bleeding and major cardiac events. Increased antithrombotic management was associated with increased bleeding risk. Further investigation is needed to clarify whether these risks are counterbalanced by reduced thromboembolic events in this population.
Copyright © 2012 Mosby, Inc. All rights reserved.

http://www.ncbi.nlm.nih.gov/pubmed/22520540