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Нестероидные противовоспалительные препараты в терапии остеоартроза: взгляд ревматолога
Нестероидные противовоспалительные препараты в терапии остеоартроза: взгляд ревматолога
Погожева Е.Ю., Амирджанова В.Н. Нестероидные противовоспалительные препараты в терапии остеоартроза: взгляд ревматолога. Consilium Medicum. Хирургия (Прил.). 2016; 1: 31–35.
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Аннотация
В статье приведен алгоритм ведения пациентов с остеоартрозом (ОА), подчеркиваются важность образовательных программ, сочетания фармакологических и нефармакологических методов лечения, подход к назначению обезболивающей терапии. Обсуждаются сложности применения нестероидных противовоспалительных препаратов (НПВП). Представлены основные положения, касающиеся развития осложнений, связанных с приемом НПВП, сформулированные в Клинических рекомендациях 2015 г. по рациональному применению НПВП в клинической практике. Приводятся основные положения, характеризующие безопасность отдельных НПВП. Отмечена необходимость индивидуального подбора НПВП. Представлены данные об особенностях фармакокинетики и фармакодинамики препарата лорноксикам (Ксефокам), показана эффективность лорноксикама в отношении болевого синдрома у больных ОА, приводятся результаты метаанализа, в котором изучались безопасность и профиль переносимости лорноксикама.
Ключевые слова: остеоартроз, нестероидные противовоспалительные препараты, лорноксикам (Ксефокам).
Key words: osteoarthritis, non-steroidal anti-inflammatory drugs, lornoxicam (Xephocam).
Ключевые слова: остеоартроз, нестероидные противовоспалительные препараты, лорноксикам (Ксефокам).
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Key words: osteoarthritis, non-steroidal anti-inflammatory drugs, lornoxicam (Xephocam).
Полный текст
Список литературы
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10. Ankier SI, Brimelow AE, Crome P et al. Chlortenoxicam pharmacokinetics in young and elderly human volunteers. Postgrad Med J 1988; 64 (756): 752–4.
11. Berg J, Fellier H, Christoph T et al. The analgesic NSAID lornoxicam inhibits cyclooxygenase (COX)-1/-2, inducible nitric oxide synthase (iNOS), and the formation of interleukin (IL)-6 in vitro. Inflamm Res 1999; 48 (7): 369–79.
12. Berry H, Bird HA, Black C et al. A double-blind, multicentre, placebo controlled trial of lornoxicam in patients with osteoarthritis of the hip and knee. Ann Rheum Dis 1992; 51 (2): 238–42.
13. Goregaonkar A, Mathiazhagan KJ, Shah RR et al. Comparative assessment of the effectiveness and tolerability of lornoxicam 8 mg BID and diclofenac 50 mg TID in adult Indian patients with osteoarthritis of the hiporknee: A 4-week, double-blind, randomized, comparative, multicenterstudy. Curr Ther Res Clin Exp 2009; 70 (1): 56–68.
14. Kidd B, Frenzel W. A multicenter randomized double blind study comparing lornoxicam with diclofenac in osteoarthritis. J Rheumatol 1996; 23 (9): 1605–11.
15. Rose P, Steinhauser C. Comparison of Lornoxicam and Rofecoxib in Patients with Activated Osteoarthritis (COLOR Study). Clin Drug Investig 2004; 24 (4): 227–36.
16. Pleiner J, Nell G, Branebjerg PE et al. Safety of lornoxicam: an interim meta-analysis of comparative clinical trials. Eur J Pain 2009; 13 (Suppl. 1): 191.
17. Темиркулова Ш.А., Имашева С.С., Жагмарова Л.К., Насырова Н.З. Опыт применения ксефокама при лечении остеоартроза у пациентов с артериальной гипертонией (АГ). Научно-практ. ревматология. 2006; 2. / Temirkulova Sh.A., Imasheva S.S., Zhagmarova L.K., Nasyrova N.Z. Opyt primeneniia ksefokama pri lechenii osteoartroza u patsientov s arterial'noi gipertoniei (AG). Nauchno-prakt. revmatologiia. 2006; 2. [in Russian]
18. Хрипунова И.Г., Хрипунова А.А., Мнацаканян С.Г. Ксефокам при купировании болевого синдрома у пациентов с остеоартрозом (ОА). Научно-практ. ревматология. 2006; 2. / Khripunova I.G., Khripunova A.A., Mnatsakanian S.G. Ksefokam pri kupirovanii bolevogo sindroma u patsientov s osteoartrozom (OA). Nauchno-prakt. revmatologiia. 2006; 2. [in Russian]
19. Верткин А.Л., Наумов А.В., Семенов П.А. и др. Оценка безопасности применения лорноксикама и диклофенака натрия в общемедицинской практике. Клин. геронтология. 2009; 15 (2): 21–6. / Vertkin A.L., Naumov A.V., Semenov P.A. i dr. Otsenka bezopasnosti primeneniia lornoksikama i diklofenaka natriia v obshchemeditsinskoi praktike. Klin. gerontologiia. 2009; 15 (2): 21–6. [in Russian]
2. Nasonov E.L. Revmatologiia: Klinicheskie rekomendatsii. M.: GEOTAR, 2005. [in Russian]
3. Karateev A.E., Nasonov E.L., Iakhno N.N. i dr. Klinicheskie rekomendatsii. Ratsional'noe primenenie nesteroidnykh protivovospalitel'nykh preparatov (NPVP) v klinicheskoi praktike. Sovrem. revmatologiia. 2015; 1: 4–23. [in Russian]
4. Bhala N, Emberson J, Merhi A et al. Coxib and traditional NSAID Trialists' (CNT) Collaboration. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomized trials. Lancet 2013; 382: 769–79.
5. Strand V. Are COX-2 inhibitors preferable to nonselective nonsteroidal anti-inflammatory drugs in patients with risk of cardiovascular events taking low-dose aspirin? Lancet 2007; 370 (9605): 2138–51.
6. Pruss TP, Stroissnig H, Radhofer-Welte S et al. Overview of the pharmacological properties, pharmacokinetics and animal safety assessment of lornoxicam. Postgrad Med J 1990; 66 (Suppl. 4): 18–21.
7. Radhofer-Welte S, Dittrich P, Simin M, Branebjerg PE. Comparative bioavailability of lornoxicam as single doses of quick-release tablet, standard tablet and intramuscular injection: a randomized, open-label, crossover phase I study in healthy volunteers. Clin Drug Investig 2008; 28 (6): 345–51.
8. Skjodt NM, Davies NM. Clinical pharmacokinetics of lornoxicam. A short half-life oxicam. Clin Pharmacokinet 1998; 34 (6): 421–8.
9. Hitzenberger G, Radhofer-Welte S, Takacs F, Rosenow D. Pharmacokinetics of lornoxicam in man. Postgrad Med J 1990; 66 (Suppl. 4): 22–7.
10. Ankier SI, Brimelow AE, Crome P et al. Chlortenoxicam pharmacokinetics in young and elderly human volunteers. Postgrad Med J 1988; 64 (756): 752–4.
11. Berg J, Fellier H, Christoph T et al. The analgesic NSAID lornoxicam inhibits cyclooxygenase (COX)-1/-2, inducible nitric oxide synthase (iNOS), and the formation of interleukin (IL)-6 in vitro. Inflamm Res 1999; 48 (7): 369–79.
12. Berry H, Bird HA, Black C et al. A double-blind, multicentre, placebo controlled trial of lornoxicam in patients with osteoarthritis of the hip and knee. Ann Rheum Dis 1992; 51 (2): 238–42.
13. Goregaonkar A, Mathiazhagan KJ, Shah RR et al. Comparative assessment of the effectiveness and tolerability of lornoxicam 8 mg BID and diclofenac 50 mg TID in adult Indian patients with osteoarthritis of the hiporknee: A 4-week, double-blind, randomized, comparative, multicenterstudy. Curr Ther Res Clin Exp 2009; 70 (1): 56–68.
14. Kidd B, Frenzel W. A multicenter randomized double blind study comparing lornoxicam with diclofenac in osteoarthritis. J Rheumatol 1996; 23 (9): 1605–11.
15. Rose P, Steinhauser C. Comparison of Lornoxicam and Rofecoxib in Patients with Activated Osteoarthritis (COLOR Study). Clin Drug Investig 2004; 24 (4): 227–36.
16. Pleiner J, Nell G, Branebjerg PE et al. Safety of lornoxicam: an interim meta-analysis of comparative clinical trials. Eur J Pain 2009; 13 (Suppl. 1): 191.
17. Temirkulova Sh.A., Imasheva S.S., Zhagmarova L.K., Nasyrova N.Z. Opyt primeneniia ksefokama pri lechenii osteoartroza u patsientov s arterial'noi gipertoniei (AG). Nauchno-prakt. revmatologiia. 2006; 2. [in Russian]
18. Khripunova I.G., Khripunova A.A., Mnatsakanian S.G. Ksefokam pri kupirovanii bolevogo sindroma u patsientov s osteoartrozom (OA). Nauchno-prakt. revmatologiia. 2006; 2. [in Russian]
19. Vertkin A.L., Naumov A.V., Semenov P.A. i dr. Otsenka bezopasnosti primeneniia lornoksikama i diklofenaka natriia v obshchemeditsinskoi praktike. Klin. gerontologiia. 2009; 15 (2): 21–6. [in Russian]
2. Насонов Е.Л. Ревматология: Клинические рекомендации. М.: ГЭОТАР, 2005. / Nasonov E.L. Revmatologiia: Klinicheskie rekomendatsii. M.: GEOTAR, 2005. [in Russian]
3. Каратеев А.Е., Насонов Е.Л., Яхно Н.Н. и др. Клинические рекомендации. Рациональное применение нестероидных противовоспалительных препаратов (НПВП) в клинической практике. Соврем. ревматология. 2015; 1: 4–23. / Karateev A.E., Nasonov E.L., Iakhno N.N. i dr. Klinicheskie rekomendatsii. Ratsional'noe primenenie nesteroidnykh protivovospalitel'nykh preparatov (NPVP) v klinicheskoi praktike. Sovrem. revmatologiia. 2015; 1: 4–23. [in Russian]
4. Bhala N, Emberson J, Merhi A et al. Coxib and traditional NSAID Trialists' (CNT) Collaboration. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomized trials. Lancet 2013; 382: 769–79.
5. Strand V. Are COX-2 inhibitors preferable to nonselective nonsteroidal anti-inflammatory drugs in patients with risk of cardiovascular events taking low-dose aspirin? Lancet 2007; 370 (9605): 2138–51.
6. Pruss TP, Stroissnig H, Radhofer-Welte S et al. Overview of the pharmacological properties, pharmacokinetics and animal safety assessment of lornoxicam. Postgrad Med J 1990; 66 (Suppl. 4): 18–21.
7. Radhofer-Welte S, Dittrich P, Simin M, Branebjerg PE. Comparative bioavailability of lornoxicam as single doses of quick-release tablet, standard tablet and intramuscular injection: a randomized, open-label, crossover phase I study in healthy volunteers. Clin Drug Investig 2008; 28 (6): 345–51.
8. Skjodt NM, Davies NM. Clinical pharmacokinetics of lornoxicam. A short half-life oxicam. Clin Pharmacokinet 1998; 34 (6): 421–8.
9. Hitzenberger G, Radhofer-Welte S, Takacs F, Rosenow D. Pharmacokinetics of lornoxicam in man. Postgrad Med J 1990; 66 (Suppl. 4): 22–7.
10. Ankier SI, Brimelow AE, Crome P et al. Chlortenoxicam pharmacokinetics in young and elderly human volunteers. Postgrad Med J 1988; 64 (756): 752–4.
11. Berg J, Fellier H, Christoph T et al. The analgesic NSAID lornoxicam inhibits cyclooxygenase (COX)-1/-2, inducible nitric oxide synthase (iNOS), and the formation of interleukin (IL)-6 in vitro. Inflamm Res 1999; 48 (7): 369–79.
12. Berry H, Bird HA, Black C et al. A double-blind, multicentre, placebo controlled trial of lornoxicam in patients with osteoarthritis of the hip and knee. Ann Rheum Dis 1992; 51 (2): 238–42.
13. Goregaonkar A, Mathiazhagan KJ, Shah RR et al. Comparative assessment of the effectiveness and tolerability of lornoxicam 8 mg BID and diclofenac 50 mg TID in adult Indian patients with osteoarthritis of the hiporknee: A 4-week, double-blind, randomized, comparative, multicenterstudy. Curr Ther Res Clin Exp 2009; 70 (1): 56–68.
14. Kidd B, Frenzel W. A multicenter randomized double blind study comparing lornoxicam with diclofenac in osteoarthritis. J Rheumatol 1996; 23 (9): 1605–11.
15. Rose P, Steinhauser C. Comparison of Lornoxicam and Rofecoxib in Patients with Activated Osteoarthritis (COLOR Study). Clin Drug Investig 2004; 24 (4): 227–36.
16. Pleiner J, Nell G, Branebjerg PE et al. Safety of lornoxicam: an interim meta-analysis of comparative clinical trials. Eur J Pain 2009; 13 (Suppl. 1): 191.
17. Темиркулова Ш.А., Имашева С.С., Жагмарова Л.К., Насырова Н.З. Опыт применения ксефокама при лечении остеоартроза у пациентов с артериальной гипертонией (АГ). Научно-практ. ревматология. 2006; 2. / Temirkulova Sh.A., Imasheva S.S., Zhagmarova L.K., Nasyrova N.Z. Opyt primeneniia ksefokama pri lechenii osteoartroza u patsientov s arterial'noi gipertoniei (AG). Nauchno-prakt. revmatologiia. 2006; 2. [in Russian]
18. Хрипунова И.Г., Хрипунова А.А., Мнацаканян С.Г. Ксефокам при купировании болевого синдрома у пациентов с остеоартрозом (ОА). Научно-практ. ревматология. 2006; 2. / Khripunova I.G., Khripunova A.A., Mnatsakanian S.G. Ksefokam pri kupirovanii bolevogo sindroma u patsientov s osteoartrozom (OA). Nauchno-prakt. revmatologiia. 2006; 2. [in Russian]
19. Верткин А.Л., Наумов А.В., Семенов П.А. и др. Оценка безопасности применения лорноксикама и диклофенака натрия в общемедицинской практике. Клин. геронтология. 2009; 15 (2): 21–6. / Vertkin A.L., Naumov A.V., Semenov P.A. i dr. Otsenka bezopasnosti primeneniia lornoksikama i diklofenaka natriia v obshchemeditsinskoi praktike. Klin. gerontologiia. 2009; 15 (2): 21–6. [in Russian]
________________________________________________
2. Nasonov E.L. Revmatologiia: Klinicheskie rekomendatsii. M.: GEOTAR, 2005. [in Russian]
3. Karateev A.E., Nasonov E.L., Iakhno N.N. i dr. Klinicheskie rekomendatsii. Ratsional'noe primenenie nesteroidnykh protivovospalitel'nykh preparatov (NPVP) v klinicheskoi praktike. Sovrem. revmatologiia. 2015; 1: 4–23. [in Russian]
4. Bhala N, Emberson J, Merhi A et al. Coxib and traditional NSAID Trialists' (CNT) Collaboration. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomized trials. Lancet 2013; 382: 769–79.
5. Strand V. Are COX-2 inhibitors preferable to nonselective nonsteroidal anti-inflammatory drugs in patients with risk of cardiovascular events taking low-dose aspirin? Lancet 2007; 370 (9605): 2138–51.
6. Pruss TP, Stroissnig H, Radhofer-Welte S et al. Overview of the pharmacological properties, pharmacokinetics and animal safety assessment of lornoxicam. Postgrad Med J 1990; 66 (Suppl. 4): 18–21.
7. Radhofer-Welte S, Dittrich P, Simin M, Branebjerg PE. Comparative bioavailability of lornoxicam as single doses of quick-release tablet, standard tablet and intramuscular injection: a randomized, open-label, crossover phase I study in healthy volunteers. Clin Drug Investig 2008; 28 (6): 345–51.
8. Skjodt NM, Davies NM. Clinical pharmacokinetics of lornoxicam. A short half-life oxicam. Clin Pharmacokinet 1998; 34 (6): 421–8.
9. Hitzenberger G, Radhofer-Welte S, Takacs F, Rosenow D. Pharmacokinetics of lornoxicam in man. Postgrad Med J 1990; 66 (Suppl. 4): 22–7.
10. Ankier SI, Brimelow AE, Crome P et al. Chlortenoxicam pharmacokinetics in young and elderly human volunteers. Postgrad Med J 1988; 64 (756): 752–4.
11. Berg J, Fellier H, Christoph T et al. The analgesic NSAID lornoxicam inhibits cyclooxygenase (COX)-1/-2, inducible nitric oxide synthase (iNOS), and the formation of interleukin (IL)-6 in vitro. Inflamm Res 1999; 48 (7): 369–79.
12. Berry H, Bird HA, Black C et al. A double-blind, multicentre, placebo controlled trial of lornoxicam in patients with osteoarthritis of the hip and knee. Ann Rheum Dis 1992; 51 (2): 238–42.
13. Goregaonkar A, Mathiazhagan KJ, Shah RR et al. Comparative assessment of the effectiveness and tolerability of lornoxicam 8 mg BID and diclofenac 50 mg TID in adult Indian patients with osteoarthritis of the hiporknee: A 4-week, double-blind, randomized, comparative, multicenterstudy. Curr Ther Res Clin Exp 2009; 70 (1): 56–68.
14. Kidd B, Frenzel W. A multicenter randomized double blind study comparing lornoxicam with diclofenac in osteoarthritis. J Rheumatol 1996; 23 (9): 1605–11.
15. Rose P, Steinhauser C. Comparison of Lornoxicam and Rofecoxib in Patients with Activated Osteoarthritis (COLOR Study). Clin Drug Investig 2004; 24 (4): 227–36.
16. Pleiner J, Nell G, Branebjerg PE et al. Safety of lornoxicam: an interim meta-analysis of comparative clinical trials. Eur J Pain 2009; 13 (Suppl. 1): 191.
17. Temirkulova Sh.A., Imasheva S.S., Zhagmarova L.K., Nasyrova N.Z. Opyt primeneniia ksefokama pri lechenii osteoartroza u patsientov s arterial'noi gipertoniei (AG). Nauchno-prakt. revmatologiia. 2006; 2. [in Russian]
18. Khripunova I.G., Khripunova A.A., Mnatsakanian S.G. Ksefokam pri kupirovanii bolevogo sindroma u patsientov s osteoartrozom (OA). Nauchno-prakt. revmatologiia. 2006; 2. [in Russian]
19. Vertkin A.L., Naumov A.V., Semenov P.A. i dr. Otsenka bezopasnosti primeneniia lornoksikama i diklofenaka natriia v obshchemeditsinskoi praktike. Klin. gerontologiia. 2009; 15 (2): 21–6. [in Russian]
Авторы
Е.Ю.Погожева, В.Н.Амирджанова*
ФГБНУ Научно-исследовательский институт ревматологии им. В.А.Насоновой. 115522, Россия, Москва, Каширское ш., д. 34а
*lifequality@yandex.ru
V.A.Nasonova Research Institute of Rheumatology. 115522, Russian Federation, Moscow, Kashirskoe sh., d. 34a
*lifequality@yandex.ru
ФГБНУ Научно-исследовательский институт ревматологии им. В.А.Насоновой. 115522, Россия, Москва, Каширское ш., д. 34а
*lifequality@yandex.ru
________________________________________________
V.A.Nasonova Research Institute of Rheumatology. 115522, Russian Federation, Moscow, Kashirskoe sh., d. 34a
*lifequality@yandex.ru
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