Research presented at the American College of Rheumatology’s (ACR) Annual Scientific Meeting suggests that acetaminophen — the medicine in the pain reliever Tylenol(R) – should be the initial therapy for the treatment of osteoarthritis (OA) pain based on cost, safety, and efficacy versus other common over-the-counter (OTC) and prescription (Rx) drugs.
“We performed a cost-effectiveness analysis of different OTC and Rx medication strategies for the treatment of OA of the knee and found that acetaminophen was most cost-effective,” says lead investigator Lisa Mandl, MD, of Brigham and Women’s Hospital in Boston. “While there is no one known cure for this potentially debilitating condition, acetaminophen is a very safe and effective option to help manage OA pain, without the cost and potential side effects of more expensive medications.”
Clinical studies have demonstrated comparable effectiveness of acetaminophen when compared with prescription anti-inflammatory medications and some doses of celecoxib and rofecoxib. According to Dr. Mandl, this study confirms the guidelines set forth in the ACR’s “Recommendations for the Medical Management of Osteoarthritis of the Hip and Knee: 2000 Update,” which recommends acetaminophen as initial drug therapy for pain of osteoarthritis, the most common form of arthritis among Americans.
Modeling different therapeutic interventions using TreeAge DATA software 3.5, Dr. Mandl’s team obtained data on drug efficacy, tolerance, and complications from reviews of published studies, with a particular focus on data from long-term randomized controlled clinical trials. Eight medication strategies were examined, and included combinations of non-steroidal anti-inflammatory drugs (NSAIDs), NSAIDs and misoprostol 200mg four times per day, a selective COX-2 inhibitor (celecoxib 200mg twice a day or rofecoxib 25mg a day), or acetaminophen 650mg four times per day. Costs for each therapeutic combination were derived from published databases. Outcome measures were quality-adjusted life expectancy (QALE) and incremental cost-effectiveness (C/E) ratios.
Osteoarthritis, the most common type of arthritis, affects more than 21 million Americans and is a leading cause of disability in the U.S. The condition is characterized by joint pain or stiffness, usually without inflammation. Specific risk factors for developing osteoarthritis include obesity, certain occupations where joints are repeatedly used, past injury, family history, and age. Before starting treatment with medications such as acetaminophen, nonpharmacologic treatment options should be tried first, including exercise and weight loss, which is consistent with the ACR guidelines.