Ketoprofen is a non-selective non-steroidal anti-inflammatory drug ( NSAID ) used to treat acute and chronic painful conditions. Dexketoprofen is the (S)-enantiomer, which is believed to confer analgesia. Theoretically Dexketoprofen is expected to provide equivalent analgesia to Ketoprofen at half the dose, with a consequent reduction in gastrointestinal adverse events.

Researchers at University of Oxford ( UK ) have assessed efficacy, duration of action, and associated adverse events of single dose oral Ketoprofen and Dexketoprofen in acute postoperative pain in adults.

Fourteen studies compared Ketoprofen ( 68 participants ) at mainly 25 mg and 50 mg with placebo ( 520 participants ). Seven studies compared Dexketoprofen ( 681 participants ) at mainly 10 mg to 25 mg with placebo ( 289 participants ).

Studies were of adequate reporting quality, and participants had pain following dental, orthopaedic, obstetric, gynaecological and general surgery. There was considerable clinical heterogeneity between studies in dental and other types of surgery, particularly bunionectomy, which limited analysis.

Ketoprofen at doses between 12.5 mg and 100 mg produced number needed to treat ( NNT ) for at least 50% pain relief over 4 to 6 hours of 2.4 to 3.3. For dental studies only there was a trend to more efficacy at higher doses, with NNT decreasing from 2.4 at 12.5 mg to 1.6 at 100 mg.

Dexketoprofen at doses of 10/12.5 mg and 20/25 mg produced NNT for at least 50% pain relief over 4 to 6 hours of 3.2 and 3.6, with no obvious dose response.

Significantly fewer participants used rescue medication with Ketoprofen and Dexketoprofen than placebo. The median time to remedication was about 5 hours with Ketoprofen and 4 hours with Dexketoprofen. The expected equivalent efficacy with a half dose of Dexketoprofen compared to Ketoprofen was not demonstrated.

Adverse events were uncommon with both drugs, and not significantly different from placebo.

In conclusion, Ketoprofen at doses of 25 mg to 100 mg is an effective analgesic in moderate to severe acute postoperative pain with an NNT for at least 50% pain relief of 3.3 with a 50 mg dose. This is similar to that of commonly used NSAIDs such as Ibuprofen ( NNT=2.5 for 400 mg dose ) and Diclofenac ( NNT=2.7 at 50 mg dose ). Duration of action is about 5 hours. Dexketoprofen is also effective with NNT of 3.2 to 3.6 in the dose range 10 mg to 25 mg. Both drugs were well tolerated in single doses.

Barden J et al, Cochrane Database Syst Rev 2009;(4):CD007355

XagenaMedicine2009


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