To the Editor:
Makris, et al are to be congratulated for highlighting potential safety advantages of topical nonsteroidal antiinflammatory drugs (NSAID) versus oral NSAID1. However, one of the 2 topical NSAID available in the United States is not well represented in their review. Only one of 19 trials that were cited evaluated diclofenac sodium 1% gel (DSG), and 5 of 19 evaluated diclofenac sodium in dimethyl sulfoxide solution (D-DMSO). Two major trials of DSG in knee osteoarthritis (OA) were published after the authors’ search period2,3, and additional subanalyses in at-risk populations have been presented4,5.
Barthel, et al3 evaluated DSG in 492 patients with knee OA. Patients treated with DSG or placebo vehicle experienced gastrointestinal (GI) adverse events (5.9% vs 5.0%, respectively) with similar frequency. However, only 2 GI adverse events (nausea, dyspepsia) were considered to be treatment-related. Similarly, Baraf, et al2 compared …
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