Clinical judgement and evidence-based medicine

Buchanan, W. Watson; Kean, Walter F.

doi:10.1016/s1297-319x(01)00292-5

Cited by 5 publications

(2 citation statements)

References 15 publications

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“…RCTs and other clinical studies focus on means and medians rather than clinical relevance to the unique individual patient (understandably so, given the statistical power and large sample sizes used). Thus, the limits of evidence‐based medicine become apparent and clinicians must use their expertise to apply the evidence in the context of the patient sitting before them [45,46] …”

Section: Discussionmentioning

confidence: 99%

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Osteoarthritis of the knee and hip. Part II: therapy with ibuprofen and a review of clinical trials

Adatia

Rainsford

Kean

2012

Journal of Pharmacy and Pharmacology

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Objectives We review the pharmacological properties and clinical evidence pertaining to the efficacy of ibuprofen as a first-line treatment in hip and knee osteoarthritis (OA). In the context of our previous paper's exploration of the aetiology and pathogenesis of OA as a basis for pharmacotherapy, we discuss the pharmacokinetics (PK) and clinical pharmacodynamics (PD) of ibuprofen relevant to OA. Key findings Although widely used, the benefits and risks of ibuprofen, especially compared with other non-steroidal anti-inflammatory drugs (NSAIDs) and placebo, have only recently been evaluated in OA of the hip and knee in randomizedcontrolled clinical trials (RCT). The efficacy and occurrence of adverse reactions from ibuprofen was compared with placebo in a structural review of the literature and systematic review of RCTs in large-scale clinical trials. Ibuprofen has been found to result in approximately 50-60% improvement over placebo in WOMAC scores, including those reflecting inflammatory joint pain in knee and hip OA or other indices of pain, disability and impaired function. Mega-trials performed in comparison with the newer NSAIDs, the coxibs, have shown that ibuprofen has comparable therapeutic benefits and although serious gastrointestinal conditions are sometimes more frequent after short-term treatment, longer-term (several months) therapy in OA reduces the advantages of the coxibs over other NSAIDs including ibuprofen. Cardiovascular risk, though present with coxibs and some NSAIDs in OA, is lower or slightly so with ibuprofen compared with coxibs. Summary Ibuprofen is effective and relatively safe (especially at low over-thecounter doses and in the short term) for mild-to-moderate OA of the knee and hip. The PK properties of ibuprofen in OA (short plasma t 1 /2) confer advantages of this drug for OA, while evidence for clinically relevant PD benefits in joints of patients with OA, though limited, is suggestive of local anti-inflammatory activity.

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Section: Discussionmentioning

confidence: 99%

“…Thus, the limits of evidencebased medicine become apparent and clinicians must use their expertise to apply the evidence in the context of the patient sitting before them. [45,46]…”

Section: Discussionmentioning

confidence: 99%

Osteoarthritis of the knee and hip. Part II: therapy with ibuprofen and a review of clinical trials

Adatia

Rainsford

Kean

2012

Journal of Pharmacy and Pharmacology

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The end of evidence-based medicine?

Clark

2012

Inflammopharmacol

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It is customary for physicians and surgeons to recommend treatments that have the highest probability of getting the patient a good outcome. Deciding treatment based on results (outcomes actually achieved) has been advocated for hundreds of years. We are now in an era when practice recommendations are supposed to be based on evidence from randomized controlled trials. There are many defects in relying on RCTs which are reviewed in this article. Advantages of observational studies are outlined, and the importance of assessing one's actual results when applying a treatment based on controlled trial evidence is set out.

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