REVIEW JURNAL

Abstract
The purpose of this study is to compare the efficacy of tramadol 37.5 mg/acetaminophen 325 mg
combination tablets (tramadol/APAP) with that of nonsteroidal anti-inflammatory drugs (NSAIDs) as
maintenance
therapy
following tramadol/APAP
and
NSAID
combination
therapy
inknee osteoarthritis (OA) pain which was inadequately controlled by NSAIDs.

Method
Subjects with knee OA for over 1 year and moderate pain (numerical rating scale [NRS] 5) despite
at least 4 weeks' NSAID therapy (meloxicam 7.5 mg or 15 mg qd or aceclofenac 100 mg bid)
received tramadol/APAP add-on (combination with NSAID) for 4 weeks. Thereafter, subjects with
significant pain improvement (NRS <4) were randomized to receive either tramadol/APAP or
NSAID for 8 weeks. On days 29 and 57, Western Ontario and McMaster Universities (WOMAC) OA
index score was measured. Secondary measures included pain intensity (NRS), pain relief score, and
subjects' and investigators' overall medication assessments

Result
Of 143 subjects enrolled, 112 completed the 4-week tramadol/APAP and NSAID combination phase
and 97 (67.8%) experienced significant pain improvement. Of the 97 subjects randomized, 36
in tramadol/APAP group and 47 in NSAID group completed the 8-week comparator study. On
days 29 and 57, WOMAC scores and pain intensities did not increase in both groups compared to
measurements immediately after the combination therapy.

Conclusion
At these two time points, there were no significant differences in WOMAC scores, pain intensities,
and other secondary measures between the two groups. Overall adverse event rates were similar in
both groups. Tramadol/APAP add-on significantly improved knee OA pain which had been
inadequately controlled by NSAIDs. In those subjects who showed favorable response
to tramadol/APAP and NSAID combination therapy, both tramadol/APAP and NSAIDs were
effective at maintaining the pain-reduced state and there was no significant difference in efficacy
between tramadol/APAP and NSAIDs.

CRITICAL APPRAISAL
VALIDITY

1. Menentukan ada atau tidaknya randomisasi dalam kelompok dan teknik randomisasi yang
digunakan

Teknik randomisasi yang digunakan

Teknik randomisasi tidak dicantumkan dalam penelitian ini
2. Menentukan ada tidaknya pertimbangan dan penyertaan semua pasien dalam pembuatan
kesimpulan
a. Mengidentifikasi lengkap atau tidaknya follow-up

b. Mengidentifikasi ada tidaknya analisis pasien pada kelompok randomisasi semula

Kriteria Inklusi

Kriteria eksklusi

3. Mengidentifikasi ada tidaknya blinding pada pasien, klinisi, dan peneliti

Tidak terdapat blinding pada penelitian ini
2

4. Menentukan ada atau tidaknya persamaan pada kedua kelompok di awal penelitian

5. Menentukan ada tidaknya persamaan perlakuan pada kedua kelompok selain perlakuan
eksperimen
Tidak ada perlakuan lain selain kedua intervensi utama yang dilakukan

APPLICABILITY
6. Menentukan kemungkinan penerapan pada pasien (spektrum pasien dan setting)

7. Menentukan potensi keuntungan dan kerugian bagi pasien

Keuntungan
3

Kerugian