Topical NSAID Selection: Diclofenac vs. Ketoprofen Plaster
Topical diclofenac plaster is preferred over ketoprofen plaster for topical NSAID treatment due to more robust evidence supporting its efficacy and safety profile. 1
Evidence for Topical NSAIDs
- Topical NSAIDs are recommended as first-line pharmacological treatment for musculoskeletal pain due to their favorable safety profile compared with oral analgesics while providing effective pain relief 1
- Topical NSAIDs show similar pain relief as oral NSAIDs but with fewer systemic side effects, making them particularly valuable for patients with risk factors for NSAID-related complications 1, 2
- The American College of Physicians (ACP) and American Academy of Family Physicians (AAFP) recommend topical NSAIDs as first-line therapy for acute musculoskeletal injuries 3
Comparative Efficacy of Diclofenac vs. Ketoprofen
Diclofenac Evidence:
- Topical diclofenac gel demonstrated small but significant improvements in pain and function after 8 weeks compared with placebo in high-quality studies 1
- Diclofenac plaster shows strong efficacy with 63-88% of patients achieving clinical success compared to 41-57% with placebo (NNT 3.2-4.7) in acute musculoskeletal pain 2
- In chronic musculoskeletal conditions (mainly osteoarthritis), topical diclofenac preparations showed 43% success rate vs. 23% for placebo in short-term use (NNT 5.0) 2
- Diclofenac shows superior results at days 1 and 2 compared to other NSAIDs for reducing pain during motion in acute ankle sprains 3
Ketoprofen Evidence:
- Ketoprofen gel showed 72% success rate vs. 33% for placebo in acute musculoskeletal pain (NNT 2.5) 2
- In chronic musculoskeletal pain, ketoprofen showed 63% success rate vs. 48% for placebo over 6-12 weeks (NNT 6.9) 4, 2
- Studies comparing diclofenac gel with ketoprofen gel showed equal efficacy between treatments 1
Safety Considerations
- Both topical diclofenac and ketoprofen have favorable safety profiles compared to oral NSAIDs 1, 4
- In acute pain conditions, systemic or local adverse event rates with topical NSAIDs (4.3%) were no greater than with topical placebo (4.6%) 2
- Moderate-quality evidence indicates no additional local adverse events with topical ketoprofen over topical placebo in chronic pain 2
- Topical diclofenac may be associated with slightly more local adverse events than placebo in chronic pain conditions (NNH 16) 2
- The most common adverse effects for both agents are mild skin reactions (pruritus or rash) at the application site 5, 6
Formulation Considerations
- The exact formulation used is critically important in determining efficacy, particularly in acute conditions 2
- Diclofenac is available in various formulations including gel, patch, and plaster, with evidence supporting each 2, 5
- Diclofenac plaster has shown particularly strong results with 88% success rate compared to 57% for placebo in some studies 2
Clinical Application
For acute musculoskeletal pain (strains, sprains, contusions):
For chronic musculoskeletal pain (osteoarthritis):
Practical Considerations
- When a large number of joints are affected, systemic pharmacological treatment may be preferred over topical NSAIDs 1
- Application should be to intact skin only, not on open wounds or lesions 2
- Topical NSAIDs should be used at the lowest effective dose and for a limited duration when possible 1
Conclusion
Based on the most recent and highest quality evidence, topical diclofenac plaster is the preferred choice over ketoprofen plaster due to more robust evidence supporting its efficacy across various pain conditions, comparable safety profile, and wider availability of formulation options 1, 2.