Ketoprofen

Defining a new class of analgesic

Client:
Rhone-Poulenc Rorer (RPR)
Category:
Pain

Cutting-edge science and differentiation

In the early 90s, several elegant studies demonstrated that postinjury pain and hypersensensitivity could not adequately be characterized as isolated peripheral events. A new phenomenon known as “central sensitization” was described. McCormack’s relational searching showed that there was only one NSAID, ketoprofen, for which the evidence supported this newly-characterized spinal cord activity as a direct target for this drug’s action. Importantly, these previously-unknown relationships identified those patient subgroups in which ketoprofen targeted non-cycloxygenase mechanisms within the spinal cord. Using the best available data, McCormack’s methods had the power to generate new teachings and to align ketoprofen with the most up-to-date understanding of postinjury pain. Inadequate data for other NSAIDs (at that time) allowed a very robust value-differentiation of ketoprofen that rapidly resulted in substantial new revenue.

Clinical implications of new teachings

The implications of these results were profound and meant that postinjury pain must be targeted both peripherally and centrally. McCormack’s findings were incorporated within the Core Curriculum of the IASP.

Using these new teachings, RPR generated US$100M of new business for ketoprofen within eighteen months (G Stanley Biostart Personal Communication 2011). In many countries ketoprofen subsequently became the NSAID of choice.

Clearly-defined subgroups include post surgical and preemptive analgesia.

A happy young girl in a hospital bed, smiling , attended by heer mother and her doctor
© Shutterstock

Key outcomes

  • Expansion of use within an approved indication

Formal presentations of new teachings by Keith McCormack

  • Pain Mechanisms. THE AGING SPINE: Pain of Spinal Origin. Continuing Medical Education Program, sponsored by The Graduate Hospital. Friday 9th May 1997, Philadelphia, Pennsylvania, United States Plenary Lecture. ‘Pain and its management’. Advanced Course in Pain and Symptom Management, Department of Experimental Psychology and Zoology, Oxford, 27th June 1996.
  • Pain and its management. Advanced Course in Pain and Symptom Management, Sir Michael Sobell House, Churchill Hospital, Oxford, 4th July 1996.
  • Progress and development in analgesia - some comments. Satellite meeting : Novel Analgesics as Tools in the Treatment of Pain. 8th World Congress on Pain, Vancouver, BC, Canada, 17th – 22nd August 1996.
  • Non-steroidal anti-inflammatory drugs (NSAID): Analgesic versus anti-inflammatory effects. Scandinavian Association for the Study of Pain 20th Annual Meeting, Scandinavian Congress Center, Aarhus, Denmark, 27th – 30th April 1997.
  • Evaluation of NSAIDs. Seminar in Palliative Care Therapeutics: NSAIDs, St Peter's College, Oxford, 21st – 22nd March 1996.
  • Current concepts of pain mechanisms. Seminar in Palliative Care Therapeutics: NSAIDs, St Peter's College, Oxford, 21st – 22nd March 1996.
  • Evidence for the dissociation of ketoprofen's analgesic and antiinflammatory activities and for different analgesic mechanisms in moderate and severe musculoskeletal pain. XIIIth European Congress of Rheumatology, Amsterdam, 18th – 23rd June 1995.
  • Central Mode of Action of NSAIDs. The Annual Scientific Meeting of the Dutch Association for Rheumatology, Amsterdam, The Netherlands. 13th May 1995.
  • Pain. A decade of discovery (1985-1995). XVI Latinamerican Congress of Orthpaedics and Traumatology and XL Colombian Congress of Orthopaedics and Traumatology, Cartagena, Colombia, 8th October 1995.
  • NSAIDs. Current concepts in pharmacology. Pain Symposium. 'Management of Pain in Orthopaedic Surgery', XVI Latinamerican Congress of Orthopaedics and Traumatology and XL Colombian Congress of Orthopaedics and Traumatology, Cartagena, Colombia. 9th October 1995.
  • Non-steroidal anti-inflammatory drugs and their analgesic performance. Chase Postgraduate Medical Centre, Chase Farm Hospital, Enfield, UK. 17th November 1993.
  • New horizons in pain therapy (telephone network link). Workshop on Pain and Sleep, Denver, Colorado, USA. 21st January 1994.
  • A new concept in rheumatology. Central Analgesic Action Symposium, Karachi, Pakistan. 21st March 1994.
  • A new concept in rheumatology.Central Analgesic Action Symposium, Lahore, Pakistan. 21st March 1994.
  • Current concepts on action and selection of NSAIDs in the management of rheumatic disease. Indonesian Rheumatism Association in co-operation with WHO - ILAR - APLAR Concord Indonesia, Surabaya, Indonesia. 25th March 1994.
  • Current concepts on action and selection of NSAIDs in the management of rheumatic disease. Indonesian Rheumatism Association in co-operation with WHO - ILAR - APLAR Concord Indonesia, Jakarta, Indonesia. 26th March 1994.
  • The Pain. Symposium, XIth Panamerican Congress of Rheumatology, Recife, Brazil. 23rd September 1994. Chairman and Presenter.
  • An overview of pain. Meeting at the Pain Department of São Paulo Medical Association, São Paulo, Brazil. 24th September 1994.
  • Can NSAIDs affect spinal nociceptive processing independently of prostaglandin synthesis inhibition? World Congress Inflammation '93. Neuronal Plasticity - Implications for Pain Therapy, Vienna, Austria. 12th October 1993.
  • The use of NSAIDs in general practice. South Essex Postgraduate Medical Centre, Basildon Hospital, Basildon, UK. 30th November 1993.
  • New horizons in the treatment of pain. The Perak Medical Practitioners' Society and the MMA Perak Branch Seminar on New Horizons in the Treatment of Pain, Ipoh, Malaysia. 28th October 1993.
  • New horizons in the treatment of pain. The Malaysian Society of Rheumatology Seminar on New Horizons in the Treatment of Pain, Kuala Lumpur, Malaysia. 29th October 1993.
  • New horizons in the treatment of pain. The Penang Medical Practitioners' Society and the MMA Penang Branch Seminar on New Horizons in the Treatment of Pain, Penang, Malaysia. 30th October 1993.
  • Neuronal plasticity means new horizons in the treatment of pain. Seminar on Update on Action & Choice of NSAIDs, Society for Emergency Medicine in Singapore, Singapore. 31st October 1993.
  • Neuronal plasticity means new horizons in the treatment of pain. Update on Action & Choice of NSAIDs Symposium, Singapore. 1st November 1993.
  • New horizons in the treatment of pain. 4th ASEAN Congress of Rheumatology, Singapore. 31st October – 4th November 1993.
  • The analgesic role of NSAIDs in the management of acute musculoskeletal trauma. Symposium, Wembley Conference Centre, London, UK. 30th April 1993.
  • NSAIDs in clinical practice. GP Refresher Course, Poole Postgraduate Centre, Poole Hospital, Poole, UK. 21st May 1993.
  • Lecture Tour. South Africa : Johannesburg, Pretoria, Cape Town, Durban. 14th – 18th June 1993. Current understanding of postinjury pain and the role of NSAIDs. A series of specialist CME Meetings.
  • Can nonsteroidal antiinflammatory drugs affect spinal nociceptive processing independently of prostaglandin synthesis inhibition?. XVIIth ILAR Congress of Rheumatology, Barcelona, Spain. 4th – 10th July 1993.
  • Can NSAIDs affect spinal nociceptive processing independently of prostaglandin synthesis inhibition? International Association for the Study of Pain (IASP), 7th World Congress on Pain, Paris, France. 22nd – 27th August 1994.
  • The analgesic role of NSAIDs in the management of acute musculoskeletal trauma. GP 3-Day Refresher Course, South Essex Postgraduate Medical Centre, Basildon Hospital, Basildon, UK. 23rd February 1993.
  • The analgesic role of NSAIDs in the management of acute musculoskeletal injuries. Postgraduate Medical Centre, Winchester Medical & Dental Federation, Royal Hampshire County Hospital, Winchester UK. 2nd March 1993.
  • The role of NSAIDs in sports medicine’. GP 3-Day Refresher Course, Christchurch Hospital, Bournemouth, UK. 15th October 1992.

Published new teachings

  • McCormack K. ‘The spinal actions of NSAIDs and the dissociation between antiinflammatory and analgesic effects’. Proceedings of a meeting at the World Congress Inflammation '93, Neuronal Plasticity - Implications for pain therapy. Guest Editors : McCormack K and Gebhart G. Drugs 1994 47(5) 28-45.
  • McCormack K. ‘Non-steroidal anti-inflammatory drugs and spinal nociceptive processing’. Pain 1994 59 9-43.
  • McCormack K, Urquhart E. ‘Correlation between nonsteroidal anti-inflammatory drug efficacy in a clinical pain model and the dissociation of their anti-inflammatory and analgesic properties in animal models’. Clinical Drug Investigation 1995 9(2) 88-97.
  • McCormack K, Brune K. ‘Dissociation between the antinociceptive and the antiinflammatory effects of the nonsteroidal antiinflammatory drugs. A survey of their analgesic efficacy’. Drugs 1991 41(4) 533-547.
  • McCormack K. ‘The spinal actions of NSAIDs and the dissociation between antiinflammatory and analgesic effects’. Proceedings of a meeting at the World Congress Inflammation ‘93, Neuronal Plasticity - Implications for pain therapy. Guest Editors : McCormack K and Gebhart G. Drugs 1994 47(5) 28-45.