The NSAID Debate
Release Date: September 6th, 2007 - Expiration Date: September 6th, 2008
Estimated Time to Complete this Activity:
One hour
Target Audience:
This activity has been designed to meet the educational need of healthcare providers in the diagnosis and management of patients with osteoarthritis. There are no prerequisites.
Statement of Need:
Arthritis is one of the most common chronic health problems and the leading cause of disability in adults in the United States. By the year 2020, approximately 60 million Americans will be affected by an arthridity or musculoskeletal disorder.
There are more than 100 different types of arthritis, and the appropriate diagnosis and treatment can present physicians significant challenges. Osteoarthritis is the most common type of arthritis, affecting approximately 12% of Americans 25 years of age and older, with incidence increasing as the population ages.
The pain and inflammation associated with osteoarthritis is often treated with common oral pain medications, including traditional nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and more recently, COX-2 inhibitors. However, their remains ongoing and new controversy specific to the value, risk, and benefits of these drugs, including gastrointestinal (GI) and cardiovascular (CV) risks. Clinicians need to understand the comparative benefits and harms of NSAIDs specific to traditional agents and the newer COX-2 inhibitors for pain management.
With the recent withdrawals of two COX-2 inhibitors due to CV safety concerns, and the CV and GI risks of NSAIDs, there is a gap in treatment options for chronic pain conditions such as osteoarthritis. However, there is a new generation of COX-2 inhibitors pending FDA approval; they include etoricoxib and lumiracoxib.
This program will offer an evidence-based review of recent clinical data that highlights the safety and efficacy issues of traditional NSAIDs and COX-2 inhibitors for the treatment of osteoarthritis, including the MEDAL (Multinational Etoricoxib and Diclofenac Arthritis Long Term) study. MEDAL assessed the relative risk of thrombolitic cardiovascular events with etoricoxib compared with diclofenac in a broad range of patients, including those with CV risk factors (including pre-existing CV disease) and GI risk factors.
Clinicians should be to able differentiate the classes of NSAIDs, and recognize the importance of patient selection when using these drugs to maximize effective treatment, and minimize safety concerns. Healthcare providers must evaluate and prescribe medications for their patients based on best evidence, clinical experience, patient-specific concerns, side effects, adverse events, drug interactions, pharmacodynamics, pharmacokinetics, and current arthritis/pain guidelines.
Educational Objectives:
Upon completion of this activity, participants should be better able to:
- Recognize the prevalence and financial impact of osteoarthritis in the United States
- Identify the relative risks (cardiovascular and gastrointestinal and benefits of nonsteroidal anti-inflammatory drugs (NSAIDs) and COX-2 inhibitors
- Recommend evidence-based treatment strategies for patients with osteoarthritis in various at-risk subpopulations
The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.
Accreditation Statement:
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Credit Designation:
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Faculty:
Joan M. Bathon, MD (Johns Hopkins Course Director)
Professor of Medicine
Director, The Johns Hopkins Arthritis Center
The Johns Hopkins University School of Medicine
Baltimore, MD
Christopher P. Cannon, MD
TIMI Study Group
Brigham and Women’s Hospital
Associate Professor of Medicine
Harvard Medical School
Boston, MA
Loren A. Laine, MD
Professor of Medicine,
Gastrointestinal and Liver Disease
University of Southern California School of Medicine
Los Angeles, CA
Faculty Disclosures:
As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of the Johns Hopkins University School of Medicine to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The presenting faculty reported the following:
Joan M. Bathon, MD:
Grant/Research Support: Bristol-Myers Squibb, Roche Pharmaceuticals, Amgen, Rinat, Biogen-Idec. Consultant: Centocor. Honorarium: Merck & Company, Inc.
Christopher P. Cannon, MD
Accumetrics; AstraZeneca; Merck; Merck/Schering Plough Partnership; Schering Plough. Consultant: Abbott; Alnylam; Arena; AstraZeneca; Biosite; BMS; Eisai, GSK;J&J; Merck; Merck/Schering Plough Partnership; Pfizer; sanofi-aventis; Schering Plough; Tethys; Vertex. Honorarium: BGB New York, DIME, I3DNL, Medscape, NCME, PRIME. Funding Received for Studies Conducted by TIMI Study Group: Brigham and Women’s Hospital: Merck; BMS; sanofi-aventis; Millennium Pharmaceuticals; Nuvelo Inc; AstraZeneca; CV Therapeutics; Inotek Pharmaceuticals; Eli Lilly; Schering-Plough Research Institute; Integrated Therapeutics Corporation; Bayer Healthcare; Ortho-Clinical Diagnostics ; sanofi-aventis; GSK; Amgen; Beckman Coulter; Biosite; Roche Diagnostics; Pfizer; Accumetrics; The NIH; Novartis
Loren A. Laine, MD
Merck & Company, Inc.; Pfizer Pharmaceutical Company; Bayer; TAP Pharmaceuticals Products, Inc. Consultant: Merck & Company, Inc.; Novartis; Bayer; Eisai; ALTANA Pharma US; Horizon Pharmaceuticals; AstraZeneca Pharmaceuticals; Santares. Honorarium: Merck & Company, Inc.
OFF-LABEL PRODUCT DISCUSSION:
No speaker has indicated that their presentation will include information on off-label products.
Disclaimer:
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of Johns Hopkins University School of Medicine name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combination of drugs, including indications, contraindications, warnings and adverse effects before administering pharmacologic therapy to patients.
Instruction:
To receive a statement of credit, you must:
- Review the full content of the activity
- Successfully complete the post-test (70% or higher)
Your statement of credit may be printed immediately upon successful completion and submission of the post-test and evaluation form.
Commercial Support:
This activity is supported by an educational grant from Merck & Company, Inc.
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Faculty Bios
Joan M. Bathon, MD
Professor of Medicine
Director, The Johns Hopkins Arthritis Center
The Johns Hopkins University School of Medicine
Baltimore, MD
Dr Bathon is professor of medicine and director of the Johns Hopkins Arthritis Center at the Johns Hopkins University School of Medicine, Baltimore, Maryland. She is also co-deputy director, Division of Rheumatology at Johns Hopkins Bayview Medical Center.
In addition to serving as a reviewer for a number of medical journals, Dr Bathon is associate editor of Arthritis Research and Therapy, advisory editor for Arthritis and Rheumatism, and a member of the editorial advisory board for Rheumatology News. She is a member of the American College of Rheumatology and American Association for the Advancement of Science, among other organizations. Dr Bathon frequently lectures on rheumatology topics and has published many articles and book chapters concerning issues in the management of rheumatoid arthritis and osteoarthritis. She also is the founder and directs the Johns Hopkins Arthritis Center Web site, which won an Award of Excellence in Professional Education from The Arthritis Foundation.
Dr Bathon earned her medical degree from the University of Maryland Medical School in Baltimore. After serving an internship and residency in medicine at the University of Maryland Hospital, she completed a fellowship in rheumatology at the Johns Hopkins University School of Medicine.
Christopher P. Cannon, MD
TIMI Study Group
Brigham and Women’s Hospital
Associate Professor of Medicine
Harvard Medical School
Boston, MA
Dr Cannon is associate professor of medicine at Harvard Medical School and associate physician in the Cardiovascular Division at Brigham and Women’s Hospital, both in Boston, Massachusetts. He is a senior investigator of the Thrombolysis in Myocardial Infarction (TIMI) Study Group, leading trials such as TACTICS-TIMI 18, PROVE IT-TIMI 22, CLARITY-TIMI 28, and MEDAL.
In addition to being a frequent lecturer, Dr Cannon has published more than 500 original articles, reviews, editorials, book chapters, and electronic publications in the field of acute coronary syndromes. His research is published in such journals as Circulation, Journal of the American College of Cardiology (ACC), Lancet, Journal of the American Medical Association, and the New England Journal of Medicine. He is editor-in-chief of Critical Pathways in Cardiology and of a 35-book series, Contemporary Cardiology. He also is an editor or author of 6 books. Dr Cannon has received numerous awards, including the Alfred Steiner Research Award, Upjohn Achievement in Research Award, and Robert F. Loeb Award for Excellence in Clinical Medicine. He is a fellow of the American Heart Association (AHA) and the ACC. He serves as chairman of the AHA’s Get With the Guidelines Science Subcommittee and of the ACC’s ACTION Registry Steering Committee. He is the principal investigator of several ongoing trials, including IMPROVE IT, which will evaluate the benefit of lowering of LDL cholesterol well below 70 mg/dL with ezetimibe plus simvastatin compared with simvastatin alone.
Dr Cannon earned his medical degree from Columbia University College of Physicians and Surgeons in New York, New York. After completing his residency in internal medicine at Columbia Presbyterian Medical Center, New York, New York, he was a cardiovascular fellow at Brigham and Women’s Hospital.
Loren A. Laine, MD
Professor of Medicine,
Gastrointestinal and Liver Disease
University of Southern California School of Medicine
Los Angeles, CA
Dr Laine is professor of medicine at the University of Southern California (USC) School of Medicine and associate director and director of Endoscopy in its Division of Gastrointestinal and Liver Diseases. In addition, he is chief of the Gastroenterology Section at Los Angeles County and USC Medical Center, all in Los Angeles, California.
A fellow of the American College of Gastroenterology (ACG) and a member of the American Gastroenterological Association (AGA) and American Society for Gastrointestinal Endoscopy, Dr Laine has chaired and served on many boards and councils of these and other national and regional medical societies. He currently is a member of the editorial boards of Clinical Gastroenterology and Hepatology, Evidence-Based Gastroenterology, American Journal of Medicine, and Alimentary Pharmacology and Therapeutics and recently was associate editor for Gastroenterology. Dr Laine has authored over 200 journal articles and book chapters on gastrointestinal (GI) conditions and disorders, most recently on Helicobacter pylori infection, the GI effects of nonsteroidal anti-inflammatory drugs, and the management of GI bleeding. He has been the recipient of the ACG Governors Award for Excellence in Clinical Research and the AGA Fitterman Foundation Clinical Research in Gastroenterology Award.
Dr Laine received his medical degree from the University of California Los Angeles (UCLA) School of Medicine. His internship and residency also were completed at UCLA, and he was a fellow in gastroenterology at the University of California San Diego.
Copyright © 2007 The Johns Hopkins University School of Medicine. All rights reserved. No part of this program may be used or reproduced in any manner whatsoever without written permission except in the case of brief quotations embodied in articles or reviews.
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