Efficacy of nimesulide for acute fever management.

In real-world clinical practice, nimesulide is effective and has good tolerability when used as an antipyretic for acute management of fever in adults during short-term use.

Fever is defined as a core temperature of 38.3°C/100.94°F or higher according to American College of Critical Care Medicine, Infectious Diseases Society of America, and International Classification of Diseases. It is often associated with cognitive impairment, discomfort, mortality, febrile seizures, morbidity, and decreased outcome in people with brain injury or stroke. It arises due to unknown or known reasons that can be further classified as acute undifferentiated fever (AUF) and pyrexia of unknown origin (PUO).

The three major types of fever are (a) Continuous or sustained fever, (b) Intermittent fever, and (c) Remittent fever. Continuous fever fluctuates around 1.5°F (1°C) for about 24 hrs. However, it never touches normal. On the other hand, intermittent fever is present only for several hours in a day. Remittent fever is a fever with daily fluctuations of greater than 2°C and does not touch the normal at any time.

In India, AUF or acute febrile illness (AFI) is one of the common causes for seeking medical assistance. This fever is characterized by a lack of localizable or organ-specific clinical features and does not extend beyond a fortnight. The paucity of accurate diagnostic methodology and non-specific signs and symptoms present a challenge to the healthcare workers. Those AUFs exhibiting a duration of illness greater than three weeks are known as PUO. To prevent early mortality, the empirical therapy for AUF should be sufficiently broad.

Management of fever includes antipyretic agents for symptomatic relief and a specific or empiric therapeutic arsenal. Pharmacological ways of antipyresis include administering antipyretics that alleviate fever mainly by suppressing prostaglandin E2 (PGE2) formation in the brain. The physical ways of antipyresis incorporate sponging with alcohol or cold water, applying ice packs and cooling fans in conjunction with sponging. Fever may exert deleterious metabolic effects liked elevated heart rate and respiration. This may pose a challenge, particularly in the elderly. Antipyretic agents can improve the accompanying responses and also minimize discomfort.

Numerous antipyretics such as nimesulide, mefenamic acid, ibuprofen, aspirin, paracetamol etc., are available and have been utilized to manage fever for a long time. Nimesulide only weakly suppresses the synthesis of prostaglandin and has different mechanisms of action. It suppresses platelet-activating factor, the release of oxidants from activated neutrophils, scavenges hypochlorous acid, and minimizes histamine release. Its greater affinity for selective inhibition of cyclooxygenase-2 (COX-2) corresponds to greater antipyretic, anti-inflammatory, and analgesic activity. In India, nimesulide has been utilized to manage fever, acute pain, dysmenorrhea, osteoarthritis, and acute tendinitis for patients >12 years of age.

RATIONALE BEHIND RESEARCH

Most studies offering evidence on the antipyretic effect of nimesulide in the adult population date back to two decades. There is a lack of most recent data demonstrating the role of nimesulide in mitigating acute fever in adults from real-world clinical settings in India. Thus, this study was performed.

OBJECTIVE

This retrospective multicenter study was performed to investigate the efficacy of nimesulide in acute fever management in Indian adults in real-world clinical practice.

Study outcomes

• The major endpoint was a decline in fever from the baseline temperature to temperature as recorded in the follow-up visit within 14 days.
• Tolerability was evaluated from the number of participants reporting side effects after ingestion of nimesulide.