Efficacy of topical NSAIDs in tendinopathies: Systematic review of randomised controlled trials

Background. Tendinopathies are a type of musculoskeletal disorder, accounting for 12.6% of general practice consultationsprescribed for this condition. Several meta-analyses concerning their topical forms have been conducted, supporting their efficacy in relieving certain musculo-skeletal disorders, albeit with low levels of evidence quality.Objective. To assess the efficacy of topical NSAIDs in the management of tendinopathies.Methods. A systematic review of the literature was carried out by searching the main medical literature databases. Only randomised trials evaluating a topical NSAID against placebo in the treatment of tendinopathies were included. Their risk of bias was assessed using the RoB2 (risk of bias 2) method. The outcome measure assessed was improvement in pain on movement. The level of evidence from the RCTs (randomised controlled trials) was assessed using the REB (Rebuild the evidence base) method.Results. Four trials with a low risk of bias were included, covering four active substances. The trials on diclofenac epolamine, ketoprofen and niflumic acid were conclusive regarding the resolution of pain on movement. The trial on diclofenac alone was inconclusive regarding this outcome measure. The assessment of efficacy using the REB method concluded that there was ‘convincing evidence to be confirmed’ for diclofenac epolamine and niflumic acid, and a ‘signal’ to be confirmed for ketoprofen. It concluded that there was a lack of evidence for diclofenac alone, indomethacin, piroxicam and ibuprofen.Conclusion. Of all the topical NSAIDs available, only diclofenac epolamine and niflumic acid have established efficacy, with a sufficient level of evidence. These results should be confirmed by a second randomised clinical trial with a low risk of bias.