Lowering side effects of NSAID usage in osteoarthritis: recent attempts at minimizing dosage

ABSTRACT

Introduction: Osteoarthritis is a burdensome disease that causes progressive damage to articular cartilage. Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the preferred treatments for symptomatic relief. However, NSAIDs can cause serious dose-dependent side effects, which has prompted experts to recommend the minimization of NSAID dosage.

Areas covered: This review focuses on three broad strategies that are currently being investigated or implemented to minimize NSAID dosage: nano-formulation, encapsulation, and topical delivery. The benefits, challenges and current status of these methods are discussed.

Expert opinion: Multiple strategies are under investigation to lower NSAID dosage. There is great potential in developing formulations that utilize more than one of these strategies together. However, there are challenges to developing these lower dose preparations.

In order to maximize the clinical potential of the abundance of NSAIDs that are both available and being developed, there is a major need for additional clinical studies directly comparing safety and efficacy of different preparations.

KEYWORDS:

• Osteoarthritis
• non-steroidal anti-inflammatory drugs (NSAIDs)
• low-dose NSAIDs
• side effects
• nano-formulation
• encapsulation
• topical delivery
• nanomedicine

Article highlights

• More guidelines and regulatory bodies are recommending that that dosage of NSAIDs be reduced because side effects are dose-dependent

• Nano-formulation, encapsulation methods, and topical preparations are some of the current strategies being used to develop lower-dose NSAID preparations

• Nano-formulation preparations indicated for osteoarthritis are commercially available

• NSAID encapsulation efforts are mostly in the animal study stage with one notable clinical study

• Topical NSAIDs are commercially available and are being increasingly recognized in osteoarthritis treatment guidelines

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. A reviewer on this manuscript has disclosed that they were (but are no longer) a consultant for Iroko and is currently a consultant for GlaxoSmithKline (formerly Novartis OTC).

Additional information

Funding

This paper was not funded