Marinho Olga Daniela Silva, Pereira Anabela
Medical Department, Bial-Portela & Ca, S.A, Coronado (S. Romão e S. Mamede), Portugal.
Research Group Ageing C, CINTESIS - Center for Health Technology and Services Research, Porto, Portugal.
Pain Ther. 2020 Dec;9(2):393-410. doi: 10.1007/s40122-020-00177-1. Epub 2020 Jun 19.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are, in general, the cornerstone of musculoskeletal pain management; however, systemic adverse events with oral formulations of NSAIDs are common. To address this problem and limit systemic exposure, topical formulations of some NSAIDs have been developed. The aim of this systematic review was to assess the available evidence on the efficacy and safety of the topical formulations of the NSAID etofenamate in patients with musculoskeletal disorders.
A systematic search of PubMed and Web of Science was conducted using the key words "topical etofenamate efficacy" OR "topical etofenamate safety" OR "topical etofenamate effectiveness" to identify studies of etofenamate published from inception to November 2018. Some published manuscripts of interest known by the authors but not identified in the PubMed search were also included to ensure the review article was as comprehensive as possible.
Overall, 12 studies were identified. These studies demonstrate that topical etofenamate [administered either in gel (5 or 10%), cream (10%) or lotion (10%) formulations)] can improve pain and reduce inflammation in patients with musculoskeletal disorders, including blunt injuries and rheumatic diseases. Etofenamate was shown to have an overall efficacy that was superior to other topical NSAIDs, such as 1% indomethacin and 1% diclofenac, and to be as effective as topical formulations of 2.5% ketoprofen gel and 2% ketorolac gel (although ketorolac showed better elimination of pain at some time points). Also, clinical evidence indicates that etofenamate is generally well tolerated in these indications.
The clinical evidence currently available suggests that etofenamate is an effective therapeutic option for the management of musculoskeletal disorders, such as blunt traumas, lumbago or osteoarthrosis. However, larger and well-controlled clinical trials comparing the efficacy and safety of etofenamate with other newer topical NSAIDs are warranted.
非甾体抗炎药（NSAIDs）通常是肌肉骨骼疼痛管理的基石；然而，口服NSAIDs制剂的全身性不良事件很常见。为了解决这个问题并限制全身暴露，已开发出一些NSAIDs的局部用制剂。本系统评价的目的是评估NSAIDs依托芬那酯局部用制剂在肌肉骨骼疾病患者中的疗效和安全性的现有证据。
使用关键词“依托芬那酯局部用疗效”或“依托芬那酯局部用安全性”或“依托芬那酯局部用有效性”对PubMed和Web of Science进行系统检索，以识别从创刊到2018年11月发表的依托芬那酯研究。作者已知但在PubMed检索中未识别的一些感兴趣的已发表手稿也被纳入，以确保综述文章尽可能全面。
总体而言，共识别出12项研究。这些研究表明，局部用依托芬那酯[以凝胶（5%或10%）、乳膏（10%）或洗剂（10%）制剂给药]可改善肌肉骨骼疾病患者的疼痛并减轻炎症，包括钝性损伤和风湿性疾病。依托芬那酯显示出总体疗效优于其他局部用NSAIDs，如1%吲哚美辛和1%双氯芬酸，并且与2.5%酮洛芬凝胶和2%酮咯酸凝胶的局部用制剂效果相当（尽管酮咯酸在某些时间点显示出更好的疼痛消除效果）。此外，临床证据表明依托芬那酯在这些适应症中通常耐受性良好。
目前可用的临床证据表明，依托芬那酯是治疗肌肉骨骼疾病（如钝性创伤、腰痛或骨关节炎）的有效治疗选择。然而，有必要进行更大规模且严格对照的临床试验，比较依托芬那酯与其他更新的局部用NSAIDs的疗效和安全性。
