Article information
Objective
To analyze the efficacy and safety of nonsteroidal anti-inflammatory drugs (NSAID) in the elderly.
MethodsWe performed a systematic review using a sensitive search strategy. All studies published in MEDLINE (since 1961), EMBASE (since 1961), and Cochrane Library (up to December 2007) were selected. We defined the population (elderly as subjects aged 60 years or above with musculoskeletal diseases), the intervention (use of NSAID), and the results related to efficacy (pain, function, and quality of life) and safety (gastrointestinal, cardiovascular, or renal toxicity). Randomized clinical trials (RCT) (Jadad 4 or 5) and high quality cohort studies were included.
ResultsA total of 101 studies were analyzed in detail, and 16 were included. More than 50000 patients aged 60 years or above were analyzed from 1 week, up to 4 years. Different NSAID were included as well as different outcomes. Four meta-analyses, 9 RCT, 2 cohort studies, and 1 cross-sectional study were included. NSAID are effective for the treatment of musculoskeletal pain, stiffness or joint function. However, NSAID are associated with an increased risk of any serious adverse events, especially serious gastrointestinal adverse events (death, hospitalization, bleeding, ulcers, obstruction). This risk decreased with the use of proton pump inhibitors.
ConclusionsBased on the evidence, NSAID in the elderly are effective for the treatment of different musculoskeletal diseases, although the risk of serious adverse events (mainly gastrointestinal) is also clearly increased.
Key words:
Non-steroidal anti-inflammatory drugs
Elderly
Efficacy
Safety
Objetivo
Analizar la eficacia y la seguridad de los antiinflamatorios no esteroideos (AINE) en ancianos.
MétodosRevisión sistemática. Se definió una estrategia de búsqueda bibliográfica sensible en MEDLINE (desde 1961), EMBASE (desde 1980) y Cochrane Library (hasta diciembre de 2007); se definió la población (ancianos: sujetos mayores de 60 años, con enfermedades reumáticas), la intervención (AINE) y los resultados; variables de eficacia (dolor, función, calidad de vida) y de seguridad (toxicidad gastrointestinal, renal y cardiovascular). Se incluyeron ensayos clínicos (EC) de 4–5 en la escala de Jadad y estudios de cohortes de máxima calidad.
ResultadosSe seleccionaron 101 artículos para lectura en detalle, de los que se incluyeron 16, que analizaron más de 50.000 ancianos, con un seguimiento que varió desde 1 semana a 4 años. Destaca la gran diversidad en cuanto al tipo de AINE y las medidas de desenlace. Se incluyeron 4 metaanálisis, 9 EC, 2 estudios de cohortes y un estudio de prevalencia. La mayoría de estos estudios analizaron a pacientes con osteoartrosis o artritis reumatoide. Los AINE en el anciano se han mostrado eficaces para el control del dolor de origen reumático, la rigidez y la función articular, pero presentan un riesgo aumentado de cualquier evento grave, especialmente gastrointestinal (muerte, hospitalización, hemorragia, ulcus u obstrucción digestiva). Este riesgo disminuye al asociarse un protector gástrico.
ConclusionesDe acuerdo con la evidencia recogida, el uso de AINE es eficaz para el tratamiento de ancianos con enfermedades reumáticas, aunque también presenta un riesgo aumentado de evento adverso grave, sobre todo de origen gastrointestinal.
Palabras clave:
Antiinflamatorios no esteroideos
Ancianos
Eficacia
Seguridad
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