Topical glyceryl trinitrate for the treatment of tendinopathies: a systematic review

Challoumas, D., Kirwan, P. D., Borysov, D., Clifford, C., McLean, M. and Millar, N. L. (2019) Topical glyceryl trinitrate for the treatment of tendinopathies: a systematic review. British Journal of Sports Medicine, 53(4), pp. 251-262. (doi: 10.1136/bjsports-2018-099552) (PMID:30301735) (PMCID:PMC6362607)

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Objective: To produce a best evidence synthesis of the clinical effects of topical glyceryl trinitrate (GTN) in the treatment of tendinopathies. Design: A systematic review of published randomised controlled trials (RCTs) of the use of GTN in patients with tendinopathy. Data sources: MEDLINE, Embase, Scopus and CINAHL from database inception to January 2018. Methods: We examined RCTs comparing the effects of topical GTN with either placebo or other treatments on tendinopathy. Overall quality of each eligible study was determined based on a combined assessment of internal validity, external validity and precision. The level of evidence for each assessed parameter was rated based on the system by van Tulder et al. Results: A total of 10 eligible RCTs were identified including patients with tendinopathy of the rotator cuff (n=4), wrist extensors (n=3), Achilles (n=2) and patellar (n=1) tendons. For all tendinopathies, improvements in pain were significant when comparing GTN versus placebo in the short term (<8 weeks; poor evidence). Significant improvements in midterm outcomes for treatment with GTN versus placebo included the following: patient satisfaction (strong evidence); chances of being asymptomatic with activities of daily living (strong evidence); range of movement (moderate evidence); strength (moderate evidence); pain (at night and with activity; poor evidence) and local tenderness (poor evidence). Patients treated with topical GTN reported a higher incidence of headaches than those who received placebo (moderate evidence). Conclusions and relevance: Treatment of tendinopathies with topical GTN for up to 6 months appears to be superior to placebo and may therefore be a useful adjunct to the treating healthcare professions.

Item Type:Articles
Glasgow Author(s) Enlighten ID:McLean, Michael and Millar, Professor Neal and Challoumas, Mr Dimitris
Authors: Challoumas, D., Kirwan, P. D., Borysov, D., Clifford, C., McLean, M., and Millar, N. L.
College/School:College of Medical Veterinary and Life Sciences > Institute of Infection Immunity and Inflammation
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:British Journal of Sports Medicine
Publisher:BMJ Publishing Group
ISSN (Online):1473-0480
Published Online:09 October 2018
Copyright Holders:Copyright © 2018 The Authors
First Published:First published in British Journal of Sports Medicine 53(4): 251-262
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
3015150Damage mechanisms in tendon diseaseNeal MillarMedical Research Council (MRC)MR/R020515/1III - Immunology
725711HMGB1: a key damage mediator in tendinopathyNeal MillarArthritis Research UK (ARTRESUK)21346III -IMMUNOLOGY