AB0808 combination of oral paracetamol and topical NSAIDS for osteoarthritis pain: a systematic scoping review of the literature
Abstract
Background Topical NSAIDs and paracetamol (APAP) are frequently used for osteoarthritis (OA) pain.1,2 In real-world settings, combination treatment is common,3,4 with more than one-quarter of patients using topical NSAIDs with oral non-opioid analgesics such as APAP.4 Objectives We conducted a systematic scoping review to: understand current recommendations on concomitant use of topical NSAIDs and APAP for OA pain; evaluate the extent of supporting evidence for this practice; and identify literature gaps. Methods We searched PubMed and the Cochrane Library for clinical studies (database inception to January 2019) of topical NSAIDs in OA in which APAP was given concomitantly, either regularly (combination treatment) or as needed (rescue treatment). Grey literature searches were conducted to identify clinical practice guidelines for management of OA from leading organizations. Results After removing duplicates, the literature searches returned 375 articles, of which 66 were clinical studies of topical NSAIDs in OA and were reviewed further. Of these, we identified 1 randomized controlled trial (RCT) evaluating efficacy and safety of combination treatment with APAP and a topical NSAID, in which 43 patients with knee OA currently treated with APAP were randomly assigned to double-blind treatment with ketoprofen plaster or placebo for 4 weeks.5 Results showed that the combination of APAP/topical ketoprofen was statistically significantly more effective in pain reduction (P=0.03)…
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