Thuốc chống viêm không steroid dùng tại chỗ cho các bệnh lý cơ xương khớp

Drugs - Tập 56 - Trang 783-799 - 2012
Jan H. Vaile1, Paul Davis2
1Department of Rheumatology, Royal Prince Alfred Hospital, Newtown, Australia
2Division of Rheumatology, University of Alberta, Edmonton, Canada

Tóm tắt

Trong những năm gần đây, ngày càng có nhiều loại thuốc chống viêm không steroid (NSAIDs) dùng tại chỗ được đưa ra. Điều này chủ yếu xuất phát từ tỷ lệ cao các sự kiện bất lợi nghiêm trọng liên quan đến đường tiêu hóa khi sử dụng NSAIDs toàn thân, và giả thuyết rằng việc giảm thiểu nồng độ thuốc hoạt động trong huyết tương có thể làm giảm số lượng tác dụng phụ toàn thân. Bằng chứng từ cả động vật và người sử dụng NSAIDs tại chỗ cho thấy nồng độ huyết tương thấp hơn so với các loại thuốc được dùng toàn thân, trong khi nồng độ trong mô mềm vẫn ở mức có thể tạo ra tác dụng chống viêm. Tuy nhiên, trong khớp, bằng chứng vẫn chưa thuyết phục, và vẫn có tranh cãi liệu trong trường hợp này thuốc có chủ yếu đến được khớp qua đường transcutaneous hay hệ thống. Đã có đủ số lượng nghiên cứu về các tình trạng mô mềm để chứng minh sự ưu việt của NSAIDs tại chỗ so với giả dược và đề xuất hiệu quả tương đương so với một vài NSAIDs đường uống. Tuy nhiên, về các bệnh khớp, tài liệu hiện có còn hạn chế hơn. Mặc dù một số nghiên cứu tuyên bố lợi ích của NSAIDs tại chỗ so với giả dược, nhưng kết quả không thuyết phục và cần thêm nghiên cứu. Các thử nghiệm thuốc tại chỗ so với corticosteroids trong khớp và các chất làm ấm còn thiếu hoặc không rõ ràng. Hồ sơ tác dụng phụ của các tác nhân tại chỗ là hợp lý: những tác dụng cutaneous nhỏ xảy ra ở tối đa 2% bệnh nhân nhưng thường có tính tự giới hạn. Các sự kiện về tiêu hóa dường như là hiếm và không nghiêm trọng theo tài liệu hiện có, mặc dù cần có các nghiên cứu dài hạn. Các trường hợp co thắt phế quản và suy thận đã được báo cáo và có thể xảy ra thường xuyên hơn ở những bệnh nhân đã trải qua các tác dụng này khi sử dụng thuốc đường uống. Chi phí ban đầu của các tác nhân tại chỗ thường cao hơn so với thuốc đường uống nhưng phân tích chi phí - hiệu quả cho thấy lợi ích tổng thể: vấn đề này cần được làm rõ hơn.

Từ khóa

#NSAIDs #thuốc chống viêm không steroid #thuốc dùng tại chỗ #bệnh lý cơ xương khớp #tác dụng phụ

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