Non-steroidal anti-inflammatory drugs: seven year's experience in preparing an annual review

Since 1980 a yearly review of the world literature on NSAID side effects has been compiled. The review looks for new information on four main topics: (1) previously unrecognized side effects of old and new drugs; (2) new information on known side effects (i.e. their frequency and the identification of "high risk" groups of patients); (3) convalidation of previously recognized side effects; and (4) comparative evaluation of the comparative side effects of NSAIDs. Our knowledge of NSAID side effects, which is improving, depends on many sources of information. Research on the mechanism of action of NSAIDs and ad hoc studies, often based on preliminary data from single case reports, have proved to be, and will probably continue to be, the most valuable sources of information. Despite the large number of articles published on this subject the information available for an appropriate comparative evaluation of the benefit/risk risk profile of NSAIDs is, at best, scanty. Many of the trials show basic design faults, the main ones being the number of patients studied, the length of treatment, the dosages employed and the subgroups of patients examined. Too much stress is laid on new "me-too" drugs and too little time and effort is dedicated to learning more about the comparative merits of old drugs. This aspect cries out urgently for appropriate research. More adequate clinical trials are required on new drugs. It is of prime importance that both available data and incoming new data be brought to the attention of all prescribing doctors to help them in the difficult task of selecting the most appropriate anti-rheumatic drug for each particular patient.