Published: 2017-01-12

Does non-steroidal anti-inflammatory drugs increase tumor necrosis factor-alpha levels?

Eylem Çağıltay, Mustafa Kaplan, Selim Nalbant, Yaşam Kemal Akpak, Burak Sahan, İbrahim Akmaz


Background: The study was designed to investigate the possible effects of the non-steroidal anti-inflammatory drugs on the levels of TNF-alpha in osteoarthritis patients.  

Methods: Three different non-steroidal anti-inflammatory drug; diclofenac sodium (100 mg), indomethacin (25 mg) and nabumethon (500 mg) have been included to the study. Twenty osteoarthritis patients who do not have another inflammatory disease for each group of NSAID were recruited from outpatients’ clinics of our hospital. Blood samples of these patients were collected before (at 0 hour) and after (at first and sixth hours) one of these NSAIDs was given orally for the sequential measurements of the serum levels of TNF-α.

Results: In all groups, levels of TNF-alpha were similar at the beginning of the study before the placebo and drugs. One hour later, after the NSAIDs were given, increased levels of TNF-alpha were obtained in diclophenac and nabumethone (55.4 ± 52.4 and 35.7 ± 27.9) groups. In contrast to diclofenac group, increased levels of TNF-alpha was insignificant in nabumethone group (P>0.05). However, at six hours later after drugs have been given, TNF-alpha levels decreased to basic levels at the beginning in only nabumethone group. Levels of the TNF-alpha in diclofenac group (101.9 ± 142.2) increased significantly at sixth hour, too. In contrast to this result, insignificant increase has been found in indomethacin and nabumethone groups (39.6 ± 34.6 and 30.2 ± 15.9). No significant changes were obtained in control group.

Conclusions: This study shows that levels of TNF-alpha may increase after NSAIDs have been taken orally. NSAIDs effects in our study, increasing TNF-alpha levels may cause unexpected results and may also alter the inflammation.  



TNF-alpha, Non-steroidal anti-inflammatory drugs, Diclofenac, Nabumethone, Indomethacin

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