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- Title
Individual responses to topical ibuprofen gel or capsaicin cream for painful knee osteoarthritis: a series of n-of-1 trials.
- Authors
Persson, Monica S M; Stocks, Joanne; Sarmanova, Aliya; Fernandes, Gwen; Walsh, David A; Doherty, Michael; Zhang, Weiya
- Abstract
Objectives To determine individual responses to ibuprofen gel or capsaicin cream for painful, radiographic knee OA using a series of n-of-1 trials. Methods Twenty-two participants were allocated 5% ibuprofen gel (A) and 0.025% capsaicin cream (B) in random sequence (AB or BA). Patients underwent up to 3 treatment cycles, each comprising one treatment for 4 weeks, an individualized washout period (maximum 4 weeks), then the other treatment for 4 weeks. Differential (ibuprofen or capsaicin) response was defined when change-from-baseline pain intensity scores (0–10 NRS) differed by ≥1 between treatments in ≥2 cycles within a participant. Results A total of 104 treatment periods were aggregated. Mean pain reduction was 1.2 (95% CI: 0.5, 1.8) on ibuprofen and 1.6 (95% CI: 0.9, 2.4) on capsaicin (P = 0.221). Of 22 participants, 4 (18%) had a greater response to ibuprofen, 9 (41%) to capsaicin, 4 (18%) had similar responses, and 5 (23%) were undetermined. Conclusion Irrespective of equal efficacy overall, 59% of people displayed a greater response to one treatment over the other. Patients who do not benefit from one type of topical treatment should be offered to try another, which may be more effective. N-of-1 trials are useful to identify individual response to treatment. Clinical trial registration https://clinicaltrials.gov , NCT03146689
- Subjects
THERAPEUTIC use of capsaicin; KNEE diseases; IBUPROFEN; CONFIDENCE intervals; INDIVIDUALITY; TREATMENT effectiveness; OSTEOARTHRITIS; DESCRIPTIVE statistics; CUTANEOUS therapeutics; CAPSAICIN
- Publication
Rheumatology, 2021, Vol 60, Issue 5, p2231
- ISSN
1462-0324
- Publication type
Article
- DOI
10.1093/rheumatology/keaa561