Topical glyceryl trinitrate for rotator cuff disease

Abstract

There is some evidence from one study at high risk of bias that topical glyceryl trinitrate is more effective than placebo for rotator cuff disease among patients with acute symptoms (< seven-days duration), but there is insufficient evidence to be certain about their longer-term effects. Headache was a common side effect in one trial and any benefits of treatment need to be balanced against the risk of headache. Further high quality research is needed to determine the effectiveness and safety of this new therapy.

Topical glyceryl trinitrate (GTN) and eccentric exercises in the treatment of mid-portion achilles tendinopathy (the NEAT trial): a randomised double-blind placebo-controlled trial

“…Although three systematic reviews have concluded that GTN is potentially beneficial in treating tendinopathy,11 48 49 our results do not support the use of topical GTN ointment in treating Achilles tendinopathy. Our findings are important and clinically relevant, as a large portion of patients who present with Achilles tendinopathy fail to make an adequate recovery with exercise interventions alone and symptoms persist in up to a quarter of patients 10 years after treatment 50…”

Topical glyceryl trinitrate (GTN) and eccentric exercises in the treatment of mid-portion achilles tendinopathy (the NEAT trial): a randomised double-blind placebo-controlled trial

“…Although three systematic reviews have concluded that GTN is potentially beneficial in treating tendinopathy,11 48 49 our results do not support the use of topical GTN ointment in treating Achilles tendinopathy. Our findings are important and clinically relevant, as a large portion of patients who present with Achilles tendinopathy fail to make an adequate recovery with exercise interventions alone and symptoms persist in up to a quarter of patients 10 years after treatment 50…”

What do Cochrane Systematic Reviews say about conservative and surgical therapeutic interventions for treating rotator cuff disease? Synthesis of evidence

“…In compliance with the inclusion criteria, eight studies were considered eligible for further qualitative analysis ( Table 2). 1,[12][13][14][15][16][17][18] Table 2. Characteristics of the interventions and main findings from comparisons between them, seen in Cochrane systematic reviews in relation to the target population (i.e.…”

Topical glyceryl trinitrate treatment of chronic patellar tendinopathy: a randomised, double-blind, placebo-controlled clinical trial

“…27 A review by Cumpston et al, in which three small studies were included of patients with rotator cuff disease who received topical GTN, alone or in combination, compared to placebo or Table 2 Main outcome measures (VISA-P and VAS during sports) at 6, 12 and 24 weeks in the glyceryl trinitrate (GTN) and placebo groups GTN (n=16) Placebo (n=17) Baseline (mean (SD)) 6 weeks (mean (SD)) 12 weeks (mean (SD)) 24 weeks (mean (SD)) Baseline (mean (SD)) 6 weeks (mean (SD)) 12 weeks (mean (SD)) 24 weeks (mean (SD)) active therapy, showed that there is insufficient evidence to be certain about their longer-term effects. 28 Kane et al 29 also found no additional clinical benefit of GTN over standard nonoperative treatment for non-insertional Achilles tendinopathy in their randomised controlled clinical trial. On the contrary, Paoloni et al have previously demonstrated efficacy of continuous topical GTN treatment in a dose of 1.25 mg/24 h using patches, when combined with daily exercise rehabilitation, in treating chronic tendinopathies including lateral epicondylosis, 15 non-insertional Achilles tendinopathy 16 and supraspinatus tendinopathy.…”

Topical glyceryl trinitrate (GTN) and eccentric exercises in the treatment of mid-portion achilles tendinopathy (the NEAT trial): a randomised double-blind placebo-controlled trial

“…Although three systematic reviews have concluded that GTN is potentially beneficial in treating tendinopathy,11 48 49 our results do not support the use of topical GTN ointment in treating Achilles tendinopathy. Our findings are important and clinically relevant, as a large portion of patients who present with Achilles tendinopathy fail to make an adequate recovery with exercise interventions alone and symptoms persist in up to a quarter of patients 10 years after treatment 50…”

What do Cochrane Systematic Reviews say about conservative and surgical therapeutic interventions for treating rotator cuff disease? Synthesis of evidence

“…In compliance with the inclusion criteria, eight studies were considered eligible for further qualitative analysis ( Table 2). 1,[12][13][14][15][16][17][18] Table 2. Characteristics of the interventions and main findings from comparisons between them, seen in Cochrane systematic reviews in relation to the target population (i.e.…”

Topical glyceryl trinitrate treatment of chronic patellar tendinopathy: a randomised, double-blind, placebo-controlled clinical trial

“…27 A review by Cumpston et al, in which three small studies were included of patients with rotator cuff disease who received topical GTN, alone or in combination, compared to placebo or Table 2 Main outcome measures (VISA-P and VAS during sports) at 6, 12 and 24 weeks in the glyceryl trinitrate (GTN) and placebo groups GTN (n=16) Placebo (n=17) Baseline (mean (SD)) 6 weeks (mean (SD)) 12 weeks (mean (SD)) 24 weeks (mean (SD)) Baseline (mean (SD)) 6 weeks (mean (SD)) 12 weeks (mean (SD)) 24 weeks (mean (SD)) active therapy, showed that there is insufficient evidence to be certain about their longer-term effects. 28 Kane et al 29 also found no additional clinical benefit of GTN over standard nonoperative treatment for non-insertional Achilles tendinopathy in their randomised controlled clinical trial. On the contrary, Paoloni et al have previously demonstrated efficacy of continuous topical GTN treatment in a dose of 1.25 mg/24 h using patches, when combined with daily exercise rehabilitation, in treating chronic tendinopathies including lateral epicondylosis, 15 non-insertional Achilles tendinopathy 16 and supraspinatus tendinopathy.…”

Topical glyceryl trinitrate (GTN) and eccentric exercises in the treatment of mid-portion achilles tendinopathy (the NEAT trial): a randomised double-blind placebo-controlled trial

“…Although three systematic reviews have concluded that GTN is potentially beneficial in treating tendinopathy,11 48 49 our results do not support the use of topical GTN ointment in treating Achilles tendinopathy. Our findings are important and clinically relevant, as a large portion of patients who present with Achilles tendinopathy fail to make an adequate recovery with exercise interventions alone and symptoms persist in up to a quarter of patients 10 years after treatment 50…”

What do Cochrane Systematic Reviews say about conservative and surgical therapeutic interventions for treating rotator cuff disease? Synthesis of evidence

“…In compliance with the inclusion criteria, eight studies were considered eligible for further qualitative analysis ( Table 2). 1,[12][13][14][15][16][17][18] Table 2. Characteristics of the interventions and main findings from comparisons between them, seen in Cochrane systematic reviews in relation to the target population (i.e.…”

Topical glyceryl trinitrate treatment of chronic patellar tendinopathy: a randomised, double-blind, placebo-controlled clinical trial

“…27 A review by Cumpston et al, in which three small studies were included of patients with rotator cuff disease who received topical GTN, alone or in combination, compared to placebo or Table 2 Main outcome measures (VISA-P and VAS during sports) at 6, 12 and 24 weeks in the glyceryl trinitrate (GTN) and placebo groups GTN (n=16) Placebo (n=17) Baseline (mean (SD)) 6 weeks (mean (SD)) 12 weeks (mean (SD)) 24 weeks (mean (SD)) Baseline (mean (SD)) 6 weeks (mean (SD)) 12 weeks (mean (SD)) 24 weeks (mean (SD)) active therapy, showed that there is insufficient evidence to be certain about their longer-term effects. 28 Kane et al 29 also found no additional clinical benefit of GTN over standard nonoperative treatment for non-insertional Achilles tendinopathy in their randomised controlled clinical trial. On the contrary, Paoloni et al have previously demonstrated efficacy of continuous topical GTN treatment in a dose of 1.25 mg/24 h using patches, when combined with daily exercise rehabilitation, in treating chronic tendinopathies including lateral epicondylosis, 15 non-insertional Achilles tendinopathy 16 and supraspinatus tendinopathy.…”