What is the preferred choice between aceclofenac and diclofenac (Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)) for treating pain and inflammation?

Aceclofenac vs Diclofenac for Pain and Inflammation

Aceclofenac is the preferred choice over diclofenac for treating pain and inflammation due to its similar efficacy but significantly better gastrointestinal safety profile. 1, 2

Comparative Efficacy

• Aceclofenac demonstrates efficacy at least equivalent to diclofenac in treating pain and inflammation in osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis 3, 2
• In a randomized double-blind comparative trial specifically comparing aceclofenac with diclofenac in osteoarthritis, aceclofenac was found to be statistically superior to diclofenac in efficacy parameters including WOMAC scores, investigator's assessment, and joint tenderness 1
• Both medications effectively reduce pain, decrease disease severity, and improve functional capacity in patients with musculoskeletal disorders 4, 5

Safety Profile Comparison

• Aceclofenac has shown a significantly better gastrointestinal tolerability profile compared to diclofenac, with lower incidence of epigastric discomfort, dyspepsia, and abdominal pain 1, 2
• Withdrawal rates due to gastrointestinal adverse events were significantly lower with aceclofenac than with other NSAIDs including diclofenac 2
• A meta-analysis of 13 comparisons with various NSAIDs including diclofenac indicated superior overall and gastrointestinal tolerability of aceclofenac 2
• Preclinical studies suggest that the potential of aceclofenac to cause gastrointestinal damage is less than that of diclofenac 3

Treatment Algorithm

1. First-line treatment: Consider paracetamol (up to 4g daily) for initial management of pain, especially in degenerative arthritis 6
2. If paracetamol is ineffective:
   • For localized pain: Consider topical NSAIDs like diclofenac gel before oral NSAIDs 7, 6
   • For widespread or more severe pain: Consider oral NSAIDs
3. When choosing an oral NSAID:
   • Aceclofenac (100mg twice daily) is preferred over diclofenac (75mg twice daily) due to better gastrointestinal safety profile with equivalent or superior efficacy 1, 2
   • Ibuprofen at lower doses (1.2g daily) may be considered as an alternative with lower gastrointestinal risk 6

Special Considerations

• For patients at high risk of gastrointestinal complications who require an NSAID, aceclofenac is a better choice than diclofenac 1, 2
• If diclofenac must be used in high-risk patients, consider adding gastroprotective agents (proton pump inhibitors or misoprostol) 6
• Elderly patients are at higher risk for NSAID-related adverse effects and require particular caution with any NSAID 6
• For patients with cardiovascular risk factors, all NSAIDs including both aceclofenac and diclofenac should be used with caution and at the lowest effective dose for the shortest duration 6

Common Pitfalls and Caveats

• Avoid long-term continuous use of any NSAID; use the lowest effective dose for the shortest duration possible 6
• Monitor for renal, cardiovascular, and gastrointestinal adverse effects with both medications, especially in elderly patients 6
• Patient compliance is typically better with aceclofenac due to fewer side effects, which may lead to better treatment outcomes 1, 5
• Consider costs related to adverse event management, which are reported to be lower with aceclofenac than with diclofenac and other comparator NSAIDs 2