Nonsteroidal anti-inflammatory drugs as the first step in treating musculoskeletal pain

Pain control is a fundamental task in the management of patients with locomotor diseases. Analgesic therapy holds the most important position in treating common diseases, such as osteoarthritis, nonspecific spinal pain, and rheumatic diseases of juxtaarticular soft tissues. Pain development and chronization in these conditions are determined by a uniform pathogenetic mechanism, the key component of which should be considered to be inflammation. This necessitates the use of antiinflammatory drugs, first of all, nonsteroidal antiinflammatory drugs (NSAIDs). When the latter are used, the risk of their adverse reactions should be necessarily taken into account and the choice of a specific drug should be based on an efficacy-safety ratio. Aceclofenac may be legally regarded as one of the most balanced NSAIDs in this respect. The paper reviews the data available in the literature on the use of this drug, including the largest clinical and epidemiological studies

A combination of naproxen and esomeprazole: Analgesic therapy on balancing cardiovascular and gastrointestinal risks

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most important tool to control pain in rheumatic diseases; however, their application is limited by the risk of serious complications in the cardiovascular system and gastrointestinal tract (GIT). The advent of a Russian new drug that is a naproxen and esomeprazole combination (Vimovo™) extends the possibilities of NSAIDS use. This review considers the benefits of both NEC components. The former is naproxen, a traditional NSAIDS that is in common use as an effective analgesic worldwide. Its chief merit is the least cardiovascular risk among all NSAIDs (aside from aspirin). Esomeprazole is a representative of the group of proton pump inhibitors, a potent antisecretory drug that has passed major tests as an agent for the prevention of NSAID-related GIT complications. This drug combination allows patient incompliance to gastroprotective therapy to be eliminated. Large-scale clinical trials have confirmed a considerable reduction in the frequency of GIT complications with NSAIDS use as compared to the standard enteric-coated naproxen, including in patients receiving low-dose aspirin. Comparison of NEC with celecoxib has indicated that the new medication is as effective as a selective COX-2 inhibitor in both efficacy and GIT safety

The first Russian strategic study of pharmacotherapy for rheumatoid arthritis (REMARCA)

The international recommendations «Treat to target» (T2T) underline the greatest importance of treatment strategy for the success of treating rheumatoid arthritis (RA). Evaluation of the efficiency of this approach obviously requires special strategic studies with an adaptive design, which substantially differ from classical randomized clinical trials and are much closer to clinical practice. To date, there are only single publications on the practical application of the T2T recommendations, there is a problem in the choice of effectiveness criteria and there are a number of other important problems associated with the introduction of these recommendations. The Russian study REMARCA is to answer these questions. Its design focuses on the practical adaptation of the T2T strategy to treat patients with earlyand extended-stage active RA who have poor prognostic factors, by using subcutaneous methotrexate and genetically engineered biological agents (GEBA). Preliminary analysis shows that therapy according to the REMARCA protocol is successful in the majority of patients. The high rate of low RA activity and remission has been achieved during subcutaneous methotrexate monotherapy. The patients who need GEBA to be incorporated may be initially more resistant to therapy. The patients with early RA have better chances of successful T2T therapy than those with extended-stage RA

New treatment possibilities for rheumatoid arthritis: the Russian experience in using certolizumab pegol

Certolizumab pegol (CZP) is a new drug from the group of tumor necrosis factor a inhibitors. The efficacy and safety CZP in the treatment of rheumatoid arthritis (RA) have been studied in the international 52-week RAPID-1 and 24-week RAPID-2 clinical trials that studied the use of CZP in combination with methotrexate (MTX) in patients with active RA unresponsive to MTX. The study populations of the RAPID 1 and RAPID 2 trials constituted the major portion of Russian patients (11.8 and 18.4%, respectively), including that in the prolonged open-labeled phases. The results of using CZP in Russian patients in the RAPID trials showed that they displayed a highly stable response to treatment and a rapidly developing clinical effect, that a therapy response could be predicted in the first 12 weeks, and that the incidence of local postinjection reactions was low