Flexiseq

Over the past few months I have had enquiries from a number of my patients regarding a product called Flexiseq. This is a topical preparation that is marketed for use in osteoarthritis of the knee. I therefore undertook a review of the literature to educate myself regarding the product.

It contains deformable phospholipid vesicles and is applied to the skin around the knee joint. It is claimed by the manufacturers that these vesicles find their way to the joint surface providing a lubricating function and in so doing the product relieves pain and improves function.

A recent article published by Conaghan et al in the Journal of Rheumatology* sheds light on this subject. The aim of the study was to assess the efficacy and safety of a 12 week treatment with a ketoprofen-containg gel, a ketoprofen-free gel (Flexiseq), oral celecoxib and an oral placebo. Ketoprofen is an anti-inflammatory medication and in South Africa the topical gel containing it is marketed as Fastum gel. Clecoxib is an oral anti-inflammatory and in our country it is marketed under the name of Celebrex.

There was no significant difference between the Flexiseq gel, Fastum gel and oral clecoxib in reducing osteoarthritis related knee pain and improving function. All three preparations were superior to oral placebo. For example oral placebo led to a 26.1% reduction of knee pain, ketoprofen gel 38.7% and Flexiseq 37%.

My opinion:

1. Topical preparations are effective in relieving osteoarthritis knee pain.
2. There are no major differences between topical preparations.
3. Newer products are often dramatically more expensive than other topical products, but not necessarily more effective.
4. I would recommend that you consult your medical doctor before using any of these products as there are certain precautions and contra-indications for certain of the products.

*A multicentre, randomized, placebo- and active-controlled trial comparing the efficacy and safety of topical ketoprofen in Transferome gel (IDEA-033) with ketoprofen-free vehicle (TDT 064) and oral celecoxib for knee pain associated with osteoarthritis. Conaghan PG, Dickson J, Bolten W, Rother M. J Rheumatology 2013:52:1303-1312.