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      "titulo" => "Clinical Role for the Professional Nurse in Rheumatology"
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    "titulo" => "Systematic Review on the Safety of Concomitant Use of Hypoglycemia-Inducing Drugs and Non-Steroidal Anti-Inflammatory Drugs in Patients With Musculoskeletal Pathology"
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      0 => array:4 [
        "autoresLista" => "Estíbaliz Loza"
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          0 => array:4 [
            "nombre" => "Estíbaliz"
            "apellidos" => "Loza"
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              0 => "eloza.hcsc@salud.madrid.org"
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            "entidad" => "Servicio de Reumatolog&#237;a&#44; Hospital Cl&#237;nico San Carlos&#44; Madrid&#44; Spain"
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        "titulo" => "Revisi&#243;n sistem&#225;tica sobre la seguridad del uso concomitante de f&#225;rmacos hipoglucemiantes y antiinflamatorios no esteroideos en pacientes con enfermedad reum&#225;tica"
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            0 => "Non-steroidal anti-inflammatory drugs"
            1 => "Steroids"
            2 => "Hypoglycemia-inducing drugs"
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            1 => "Esteroides"
            2 => "Hipoglucemiantes"
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      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To analyze the safety of combining non-steroidal anti-inflammatory drugs &#40;NSAID&#41; and hypoglycemia-inducing drugs&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A systematic review following a sensitive search strategy was performed&#46; All articles published in MEDLINE &#40;since 1961&#41;&#44; EMBASE &#40;since 1961&#41;&#44; and Cochrane Library&#44; up to December 2007&#44; were examined&#46; Selection criteria&#58; the population &#40;subjects taking hypoglycemia-inducing drugs&#58; insulin or oral antidiabetic drugs &#91;OAD&#93;&#41;&#44; the intervention &#40;concomitantly use of NSAID&#41;&#44; and the outcomes related to safety &#40;gastrointestinal&#44; renal&#44; cardiovascular toxicity&#41; and glycemic control&#46; Titles and abstracts of retrieved articles meeting inclusion criteria from the search were reviewed&#46; Only randomized controlled trials &#40;RCT&#41;&#44; or cohort studies were included&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 33 studies were reviewed in detail&#44; and 11 were finally included&#44; 10 low quality RCT&#44; and 1 prospective cohort study with moderate quality&#44; which included 199 patients&#46; All patients were diabetics&#59; mostly young or middle aged men&#44; on different NSAID and hypoglycemic drugs&#46; There was no evidence of important changes in patient&#39;s glycemic controls&#44; nor in their renal function&#44; when combining NSAID with hypoglycemia-inducing drugs&#46; Moreover&#44; there is no clear increase in the number of serious side effects&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">According to the published evidence&#44; there are not enough arguments to contraindicate the use of NSAID with hypoglycemia-inducing drugs &#40;insulin or OAD&#41;&#46;</p>"
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        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Analizar la seguridad del uso concomitante de antiinflamatorios no esteroideos &#40;AINE&#41; y f&#225;rmacos hipoglucemiantes que permita la toma de decisiones en este sentido en la pr&#225;ctica diaria&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Revisi&#243;n sistem&#225;tica&#46; Se defini&#243; una estrategia de b&#250;squeda bibliogr&#225;fica sensible en MEDLINE &#40;desde 1961&#41;&#44; EMBASE &#40;desde 1980&#41; y Cochrane Library hasta diciembre de 2007&#44; definiendo la poblaci&#243;n &#40;sujetos en tratamiento con f&#225;rmacos hipoglucemiantes&#44; tanto insulina como antidiab&#233;ticos orales &#91;ADO&#93;&#41;&#44; la intervenci&#243;n &#40;tratamiento concomitante con AINE&#41; y los resultados &#40;variables relacionadas con la seguridad&#8211;toxicidad gastrointestinal&#44; renal o cardiovascular&#8211; y con el control gluc&#233;mico&#41;&#46; Se seleccionaron ensayos cl&#237;nicos &#40;EC&#41; y estudios de cohortes de calidad&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se encontraron 33 estudios para analizar en detalle&#44; de los cuales finalmente se incluyeron 11 en los an&#225;lisis&#44; de los que 10 fueron EC&#44; en general de baja calidad&#44; y 1 estudio de cohortes prospectivas de calidad moderada&#44; que en total incluyeron a 199 pacientes&#46; Todos los pacientes eran diab&#233;ticos&#44; la mayor&#237;a varones j&#243;venes o de mediana edad en tratamiento con diferentes AINE y f&#225;rmacos hipoglucemiantes&#46; El uso de AINE con f&#225;rmacos hipoglucemiantes no parece estar claramente asociado a cambios importantes en el control gluc&#233;mico de estos pacientes ni se ha visto que altere significativamente su funci&#243;n renal&#46; Tampoco se ha constatado que esta asociaci&#243;n aumente el n&#250;mero de eventos adversos graves&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Por la evidencia obtenida&#44; no encontramos argumentos suficientes que claramente contraindiquen&#44; debido a efectos secundarios&#44; el uso concomitante de AINE e hipoglucemiantes &#40;tanto ADO como insulina&#41;&#46;</p>"
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                      "titulo" => "Advances in the adverse effects of NSAIDs in the gastrointestinal tract"
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                      "titulo" => "Effects of imidazole-2-hydroxibenzoate on glycosaminoglycan and albumin urinary excretion in type 1 diabetic patients"
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                      "titulo" => "Short-term inhibition of prostaglandin synthesis has no effect on the elevated glomerular filtration rate of early insulin-dependent diabetes"
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Vol. 4. Issue 6.
Pages 232-239 (November - December 2008)
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Vol. 4. Issue 6.
Pages 232-239 (November - December 2008)
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Systematic Review on the Safety of Concomitant Use of Hypoglycemia-Inducing Drugs and Non-Steroidal Anti-Inflammatory Drugs in Patients With Musculoskeletal Pathology
Revisión sistemática sobre la seguridad del uso concomitante de fármacos hipoglucemiantes y antiinflamatorios no esteroideos en pacientes con enfermedad reumática
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Estíbaliz Loza
Corresponding author
eloza.hcsc@salud.madrid.org

Correspondence: Hospital Clínico San Carlos. Prof. Martín Lagos, s/n. 28015 Madrid. España.
Servicio de Reumatología, Hospital Clínico San Carlos, Madrid, Spain
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Abstract
Objectives

To analyze the safety of combining non-steroidal anti-inflammatory drugs (NSAID) and hypoglycemia-inducing drugs.

Methods

A systematic review following a sensitive search strategy was performed. All articles published in MEDLINE (since 1961), EMBASE (since 1961), and Cochrane Library, up to December 2007, were examined. Selection criteria: the population (subjects taking hypoglycemia-inducing drugs: insulin or oral antidiabetic drugs [OAD]), the intervention (concomitantly use of NSAID), and the outcomes related to safety (gastrointestinal, renal, cardiovascular toxicity) and glycemic control. Titles and abstracts of retrieved articles meeting inclusion criteria from the search were reviewed. Only randomized controlled trials (RCT), or cohort studies were included.

Results

A total of 33 studies were reviewed in detail, and 11 were finally included, 10 low quality RCT, and 1 prospective cohort study with moderate quality, which included 199 patients. All patients were diabetics; mostly young or middle aged men, on different NSAID and hypoglycemic drugs. There was no evidence of important changes in patient's glycemic controls, nor in their renal function, when combining NSAID with hypoglycemia-inducing drugs. Moreover, there is no clear increase in the number of serious side effects.

Conclusions

According to the published evidence, there are not enough arguments to contraindicate the use of NSAID with hypoglycemia-inducing drugs (insulin or OAD).

Key words:
Non-steroidal anti-inflammatory drugs
Steroids
Hypoglycemia-inducing drugs
Resumen
Objetivos

Analizar la seguridad del uso concomitante de antiinflamatorios no esteroideos (AINE) y fármacos hipoglucemiantes que permita la toma de decisiones en este sentido en la práctica diaria.

Métodos

Revisión sistemática. Se definió una estrategia de búsqueda bibliográfica sensible en MEDLINE (desde 1961), EMBASE (desde 1980) y Cochrane Library hasta diciembre de 2007, definiendo la población (sujetos en tratamiento con fármacos hipoglucemiantes, tanto insulina como antidiabéticos orales [ADO]), la intervención (tratamiento concomitante con AINE) y los resultados (variables relacionadas con la seguridad–toxicidad gastrointestinal, renal o cardiovascular– y con el control glucémico). Se seleccionaron ensayos clínicos (EC) y estudios de cohortes de calidad.

Resultados

Se encontraron 33 estudios para analizar en detalle, de los cuales finalmente se incluyeron 11 en los análisis, de los que 10 fueron EC, en general de baja calidad, y 1 estudio de cohortes prospectivas de calidad moderada, que en total incluyeron a 199 pacientes. Todos los pacientes eran diabéticos, la mayoría varones jóvenes o de mediana edad en tratamiento con diferentes AINE y fármacos hipoglucemiantes. El uso de AINE con fármacos hipoglucemiantes no parece estar claramente asociado a cambios importantes en el control glucémico de estos pacientes ni se ha visto que altere significativamente su función renal. Tampoco se ha constatado que esta asociación aumente el número de eventos adversos graves.

Conclusiones

Por la evidencia obtenida, no encontramos argumentos suficientes que claramente contraindiquen, debido a efectos secundarios, el uso concomitante de AINE e hipoglucemiantes (tanto ADO como insulina).

Palabras clave:
Antiinflamatorios no esteroideos
Esteroides
Hipoglucemiantes
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