Survey							
                            
		                
		                * Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
TAASS Claims Contents TAASS claims summary Traumeel ointment and gel are as effective as diclofenac gel in the treatment of pain in acute ankle sprain Traumeel ointment and gel are as effective as diclofenac gel in function improvement in acute ankle sprain Traumeel ointment and gel are as effective as diclofenac gel in reducing ankle swelling in acute ankle sprain in all secondary endpoint variables Traumeel ointment and gel are as effective as diclofenac gel for global efficacy in acute ankle sprain Traumeel ointment and gel are as effective as diclofenac gel for time to normal function in acute ankle sprain In the TAASS study, all treatment arms were well tolerated Traumeel ointment and gel are both well tolerated and effective alternatives to diclofenac gel for the treatment of pain and function in patients with acute ankle sprain TAASS in perspective Traumeel – evidence base Appendix TAASS claims summary The Significance of TAASS Traumeel has been shown to be as effective as diclofenac in a randomized controlled study (TAASS study), which is a ‘gold standard’ study design The TAASS study is a significant and robust addition to the evidence base comparing a natural medicine with a conventional medicine (diclofenac) The TAASS study complements the existing data from double-blind and/or randomized placebo controlled trials with Traumeel1 The TAASS study confirms that Traumeel ointment and gel is as effective as diclofenac The TAASS study provides confirmatory evidence that Traumeel provides an effective alternative to diclofenac for the treatment of musculoskeletal disorders and inflammation Therefore, being as effective as diclofenac is THE major claim! NSAID, non-steroidal anti-inflammatory drug; 1. Linde K et al. Lancet 1997;350:834–43 Claims Summary – TAASS Study Traumeel ointment and Traumeel gel are as effective as diclofenac gel 1% for the treatment of pain and restoration of function associated with acute mild to moderate ankle sprain By day 7, patients reported over 60% reduction in pain Reductions in VAS pain score were over 93% on day 14 and total pain relief (100%) was reported by all patients at 6 weeks By day 7, patients’ function was improved by about 35% from baseline taking function to about 80% of what patients considered to be normal Function was improved by about 45% from baseline taking ankle function to about 95% of what patients considered to be normal on day 14; normal function was restored in all patients by 6 weeks Claims Summary – TAASS Study Both Traumeel ointment and gel were also proven to be as effective as diclofenac gel for secondary endpoint variables including:  FAAM sports subscale  current level of function during daily living activity  current level of function during sports-related activities  swelling  assessment of normal function  global efficacy All secondary parameters returned to normal by 6 weeks Time to normal function was about 19 days for all groups All treatments were equally well tolerated: Traumeel ointment, Traumeel gel and diclofenac gel 1% Claims Traumeel ointment and gel are as effective as diclofenac gel in the treatment of pain in acute ankle sprain Efficacy Claim – Reducing Pain Claim  Traumeel ointment and Traumeel gel are both as effective as diclofenac gel for reducing ankle pain at day 7 of treatment and, after 6 weeks from injury, all patients are pain free Key Note  Diclofenac is a marker of efficacy  Traumeel is now proven to be an equally effective agent  This effect holds true for the different topical formulations Efficacy Claim – Reducing Pain Key Messages  Traumeel gel and ointment performed as well as diclofenac gel  Significant reductions in ankle pain were seen by all agents on day 4  All patients had negligible pain after 14 days  Traumeel has been shown to be an equally effective agent to diclofenac  Because this claim holds for the primary efficacy variable, pain reduction, this study is positive for Traumeel Efficacy Claim – Reducing Pain Traumeel is as effective as NSAIDs in reducing pain Traumeel ointment (O) N = 143 % median change in VAS score of ankle pain 0 Day 4 Traumeel gel (G) N = 140 Day 7 Diclofenac gel (D) N = 137 Day 14 Day 42 -20 -40 O vs. D: p=0.5069 G vs. D: p=0.1131 -60 -80 -100 O vs. D: p=0.8205 G vs. D: p=0.3422 Primary efficacy endpoint: percentage change from baseline at day 7 O vs. D: p=0.7312 G vs. D: p=0.7640 O vs. D: p=0.9267 G vs. D: p=0.8314 Efficacy Claim – Reducing Pain Traumeel is as effective as NSAIDs in reducing pain Traumeel ointment N = 143 Traumeel gel N = 140 Diclofenac gel N = 137 Median VAS score of ankle pain 60 50 40 30 20 10 0 Baseline Day 4 Day 7 Day 14 A patient’s assessment of ankle pain was performed using a 100 mm VAS (0=no pain; 100=worst pain imaginable) Day 42 Efficacy Claim – Reducing Pain At each level of pain reduction (i.e. 100%, ≥ 80%, ≥ 50% and ≥ 20%), a similar proportion of patients reported pain reduction in the three treatment groups at day 7 (see table below and next slide) Further evidence that Traumeel is an equally effective agent to diclofenac Traumeel ointment Traumeel gel Diclofenac gel 8.5% 5.0% 5.9% at least 80% reduction in pain 34.5% 36.4% 33.8% at least 50% reduction in pain 62.7% 74.3% 74.3% at least 20% reduction in pain 93.0% 94.3% 94.9% total pain relief Efficacy Claim – Reducing Pain on Day 7 This again shows that, however you look at the data, Traumeel’s performance matches that of diclofenac Traumeel ointment N = 143 Traumeel gel N = 140 Diclofenac gel N = 137 100 Patients (%) 80 60 40 20 0 ≥20% ≥50% ≥80% At each level of pain reduction (i.e. 100%, ≥ 80%, ≥ 50% and ≥ 20%), a similar proportion of patients reported pain reduction in the three treatment groups at day 7 100% Claims Traumeel ointment and gel are as effective as diclofenac gel in function improvement in acute ankle sprain Efficacy Claim – Improving Function Claim  Traumeel ointment and Traumeel gel are both as effective as diclofenac gel for improving function during daily activities of living at day 7 of treatment and, after 6 weeks from injury, all patients are back to normal function Key Note  It is the lack of function - apart from the pain - that causes the most distress for patients and necessitates early and effective treatment  This ensures that patients are returned to normal daily life as soon as possible  Importantly, Traumeel will do this as effectively as diclofenac Efficacy Claim – Improving Function Claim  The improvement in function during daily activities of living at day 7 of treatment with Traumeel ointment (score 26.2) or with Traumeel gel (score 26.2) is comparable to that of diclofenac gel (score 25) Note  This is a key measure of efficacy and relates to the improved quality of life that patients can expect after using Traumeel  That this efficacy is equivalent to that of diclofenac should give both patients and doctors confidence Efficacy Claim – Improving Function Key Messages  Traumeel is as effective as diclofenac in enabling patients to return to their normal daily life  Traumeel has been shown to be an equally effective agent to diclofenac  Because this claim holds for the primary efficacy variable, improvement in function, this study is positive for Traumeel Efficacy Claim – Improving Function Traumeel is as effective as NSAIDs in improving function Traumeel ointment N = 143 Traumeel gel N = 140 Diclofenac gel N = 137 Median change from baseline in ADL subscale score 60 O vs. D: p=0.4030 G vs. D: p=0.7588 50 O vs. D: p=0.4963 G vs. D: p=0.6665 40 O vs. D: p=0.3155 G vs. D: p=0.1584 30 20 O vs. D: p=0.6234 G vs. D: p=0.5350 10 0 Day 4 Day 7 Day 14 Higher scores represent higher levels of physical function Day 42 Efficacy Claim – Improving Function Traumeel is as effective as NSAIDs in improving function Traumeel ointment N = 143 Traumeel gel N = 140 Diclofenac gel N = 137 Median ADL subscale score 100 80 60 40 20 0 Baseline Day 4 0=worst level of physical function, 100=highest level of physical function Day 7 Day 14 Day 42 Claims Traumeel ointment and gel are as effective as diclofenac gel in reducing ankle swelling in acute ankle sprain in all secondary endpoint variables Secondary Efficacy Variables The treatment groups were also proven as effective as diclofenac for secondary endpoint variables: Secondary endpoint variable Description FAAM sports subscale Measuring patients’ sports performance Current level of function during daily living activity Measuring how patients function going about their daily activities Current level of function during sports-related activities Measuring how patients function during sports Current level of function Measuring how patients function overall Swelling Measuring reduction in ankle swelling Assessment of normal function Measuring if patients function as normal Global efficacy assessment Patients rating of overall treatment efficacy Time to normal function: training and sports Measuring the time taken for patients to resume training and to resume sports All secondary parameters returned to normal by 6 weeks for all three groups: Traumeel ointment, Traumeel gel, diclofenac gel Efficacy Claim – Secondary Endpoint Variables A comparable reduction in swelling (as demonstrated by reduction in circumference) was seen in all groups at day 7 Baseline median cm Day 7 median cm (change from baseline) Traumeel ointment 55.1 53.9(-0.5) Traumeel gel 54.1 53.0 (-0.5) Diclofenac 54.0 53.1(-0.5) Efficacy Claim – Secondary Endpoint Variable: Swelling Claim  Traumeel ointment and Traumeel gel are each as effective as diclofenac gel for reducing ankle swelling at day 7 of treatment  The reduction in ankle swelling at day 7 of treatment with Traumeel ointment (0.5 cm) or with Traumeel gel (0.5 cm) is comparable to that of diclofenac gel (0.485 cm) Key Note  Swelling, along with stiffness, is a key symptom in soft tissue injury. Reducing it is a mark of effectiveness for any agent  Further evidence that Traumeel is an equally effective agent to diclofenac Efficacy Claim – Secondary Efficacy Variable: Swelling Swelling was reduced from baseline in all groups at all time points 0 Day 4 Day 7 Day 14 Median changes in swelling ‘figure-of-eight’ (cm) -0.1 -0.2 -0.3 -0.4 O vs.. D: p=0.5096 G vs. D: p=0.2236 -0.5 -0.6 O vs. D: p=0.3895 G vs. D: p=0.2000 -0.7 O vs. D: p=0.1454 G vs. D: p=0.1295 -0.8 Traumeel ointment (O) N = 143 Traumeel gel (G) N = 140 Diclofenac gel (D) N = 137 Greater changes represent greater improvement (reduced swelling) Claims Traumeel ointment and gel are as effective as diclofenac gel for global efficacy in acute ankle sprain Efficacy Claim – Secondary Endpoint Variable: Global Efficacy At day 14 treatments were rated as ‘very good’/’good’ by the vast majority of patients:  Traumeel ointment: 92.25% of patients  Traumeel gel: 92.09% of patients  Diclofenac gel: 92.70% of patients Over 92% of patients in each group rated the treatment as “very good” or “good” Comparable efficacy was demonstrated for Traumeel vs. diclofenac Treatment Very good Good Satisfactory No improvement Worse Traumeel ointment 72 (50.7%) 59 (41.6%) 10 (7.0%) 1 (0.7%) 0 Traumeel gel 69 (49.6%) 59 (42.5%) 11 (7.9%) 0 0 Diclofenac gel 74 (54.0%) 53 (38.7%) 10 (7.3%) 0 0 Claims Traumeel ointment and gel are as effective as diclofenac gel for time to normal function in acute ankle sprain Efficacy Claim – Secondary Endpoint Variable: Time to Normal Function All groups were equally comparable for time to training and time to sports Treatment Time to training (days) Time to sports (days) Traumeel ointment 14.30 19.09 Traumeel gel 14.32 19.35 Diclofenac gel 14.61 19.39 Efficacy Claim – Secondary Endpoint Variable: Time to Normal Function Claims  The ultimate clinical objective must be the return to normal daily living. Returning to sports activities is probably the most extreme test of that.  Further evidence that Traumeel is an equally effective agent to diclofenac In the TAASS study, all treatment arms were well tolerated TAASS Safety The key claim is that both Traumeel gel and ointment and diclofenac gel had similar tolerability profiles  this is to be expected for topical preparations, especially when used acutely (i.e. for a short time) The majority of events were mild or moderate in severity; none was serious  At 6 weeks, most (41/43) adverse events had resolved Traumeel has previously been reported to be well tolerated and without treatment-related adverse effects, including in:  patients with other indications, e.g. various musculoskeletal sports injuries, post-traumatic hemarthrosis, epicondylitis  other studies using ointment, and other routes of administration, e.g. injection, tablets and gel TAASS Claims Summary In general, good safety and tolerability can be assessed for all three study treatments This topical study is a robust addition to the Traumeel evidence base and ensures that the product can be seen as an effective treatment option for musculoskeletal disorders Claims Traumeel ointment and gel are both well tolerated and effective alternatives to diclofenac gel for the treatment of pain and function in patients with acute ankle sprain TAASS Efficacy Summary Efficacy Evidence from a ‘gold’ standard design trial in patients with acute ankle sprain, that Traumeel ointment and gel are as effective as diclofenac gel in:  reducing pain  improving function  reducing swelling  time to return to normal function All secondary parameters returned to normal by 6 weeks Median time to normal function was about 19 days for all groups TAASS Safety Summary Safety The majority of events were mild or moderate in severity; none was serious  9/152 patients (5.9%) in the Traumeel ointment group  14/148 patients (9.5%) in the Traumeel gel group  8/147 patients (5.4%) in the diclofenac gel group There were no findings of clinical relevance At 6 weeks, most (41/43) adverse events had resolved Traumeel is as well tolerated as diclofenac gel 1% This topical study is a robust addition to the Traumeel evidence base and ensures that the product can be seen as an effective treatment option for musculoskeletal disorders TAASS in Perspective This topical study is a robust addition to the Traumeel evidence base and ensures that the product can be seen as an effective treatment option for musculoskeletal disorders Evidence from in vitro and pre clinical studies show that the mechanism of action of Traumeel has a beneficial effect on both tissue repair and accelerated wound healing1-5  It can be concluded that components of Traumeel may promote recovery and may speed up the healing process  Traumeel provides a multitargeted, synergistic action to address multiple aspects of the inflammatory process and may promote healing Evidence from previous studies with Traumeel demonstrate a better tolerability profile compared to NSAIDs 6,7 Another reason to switch to Traumeel – better tolerability with the added benefit of accelerated healing 1.Heine H, Schmolz M. Biomed Ther. 1998;XVI(3):224–226. 2. Heine H, Andrä F. Ärztezeit f Naturheilverfahrenn. 2002;43(2):96–104. 3. Lussignoli S et al. Complement Ther Med. 1999;7(4):225–230. 4. Porozov et al. Clin Dev Immunol. 2004;11(2):143–149. 5. Conforti A et al. Biomed Ther. 1997;XV(1):28–31. 6. Birnesser H et al. J Musculoskel Res. 2004;2/3:119–128;7 Schneider C. Complement Ther Med 2008; 16(1):22–27 TAASS in Perspective Safety In a 4 week study it was concluded that Traumeel is safe and welltolerated in healthy subjects, and should be considered as a safer alternative to NSAIDs, particularly in patients with conditions or receiving medications that affect normal coagulation.1 Traumeel has previously been reported to be well tolerated and without treatment-related adverse effects 2-9 1.Arora S, Harris T, Scherer C. Biomed Ther. 2000;XVIII(2):222–225. 2. Schneider C et al. Explore. 2005;1:446–452; 3. Böhmer D & Ambrus P. Biol Ther. 1992;10:290–300; 4. Thiel W. Biol Ther. 1994;XII:242–248; 5. Birnesser H et al. J Musculoskel Res. 2004;2/3:119–128; 6. Zenner S & Metelmann H. Biol Ther. 1992;X:301–310; 7. Zenner S & Metelmann H. 1994;XII:204–211; 8. Zenner S & Weiser M. Biomed Ther.1997;XV:22–26; 9. Schneider C et al Complement Ther Med. 2008;16:22–27 Traumeel in Perspective Safety The long-term efficacy of topical NSAIDs is controversial.1 Topical NSAIDs - often recommended for patients who are unable to tolerate the GI side effects of systemic NSAIDs.  a systematic review of topical NSAIDs in older patients with osteoarthritis OA found that while topical application is associated with lower incidence of GI side effects2  up to 15% of patients experienced a GI-related side effect  up to 39.3% reported application site side effects, including local skin sensitivity, contact dermatitis, and photodermatitis. 1. Lin J BMJ, doi:10.1136/bmj.38159.639028.7C. 2. Makris UE AJ Rheumatol. 2010 June ; 37(6): 1236–1243. Traumeel in Perspective Safety Despite favorable evidence of safety and tolerability, the FDAapproved topical NSAIDs carry the same black box warnings as oral diclofenac concerning the risk of gastrointestinal and cardiovascular AEs, as well as hepatic abnormalities.1,2 1.Barkin RL Drugs Aging 2010. 2. Roth HS. The Physician and Sportsmedicine. Vol 39. 2011. Traumeel – Previous Studies Traumeel has previously been reported to be well tolerated and without treatment-related adverse effects, including in:  patients with other indications, e.g. various musculoskeletal sports injuries, post-traumatic hemarthrosis, epicondylitis  other studies using ointment, and other routes of administration, e.g. injection and tablets Traumeel has shown that is as effective as diclofenac with a better tolerability profile  Tolerability assessed as “very good” by 88% of Traumeel patients and 45% NSAIDs patients1  Physician-rated tolerability was “very good” for 90% of Traumeel cases vs. 50% of conventional cases (P = 0.01)2 This topical study is a robust addition to the Traumeel evidence base and ensures that the product can be seen as an effective treatment option for musculoskeletal disorders 1. Birnesser H, et al. J Musculoskel Res 2004;8(2–3):119–128. 2. Schneider C, et al. Complement Ther Med. 2008,16(1):22–27. Traumeel’s Evidence Base of Efficacy and Safety in Various Musculoskeletal Conditions - Summary Study Musculoskeletal Conditions Study type RCT Observational study √ Efficacy better vs. placebo Pain Mobility √ √ Efficacy equal vs. NSAIDs Pain Zell et al. 19891 Ankle sprain Birnesser et al. 20042 Epicondylitis √ Schneider et al. 20053 Tendinopathy √ √ Schneider et al. 20084 Musculoskelet al injuries √ √ Orizola & Vargas 20075 Tendinopathy √ √ √ Mobility Efficacy better vs. NSAIDs Safety vs. NSAIDs Pain Mobility Equal √ √ √ Better √ √ √ √ 1. Zell J et al. Biol Ther. 1989;VII(1):1–6; 2. Birnesser H et al. J Musculoskel Res. 2004;2/3:119–128; 3. Schneider C et al. Explore. 2005;1:446–452; 4. Schneider C, et al. Complement Ther Med. 2008;16:22–27; 5. Orizola AJ, et al. Med & Sci Sports & Exercise 2007;39 (suppl):S79. √ √ Summary - Traumeel Traumeel has fewer side effects than NSAIDs Traumeel can be used in all age groups Traumeel is better tolerated than NSAIDs Traumeel is available in tablets, ointment, gel and ampoules, thereby enabling flexibility of administration Traumeel’s unique multitargeted, synergistic action addresses multiple aspects of the inflammatory process. This unique mechanism of action may promote both tissue repair and healing, whereas NSAIDs have been proven to have deleterious effect on healing process in soft tissues Traumeel is better tolerated than NSAIDs. Another reason to switch to Traumeel – better tolerability with the added benefit of a multi-targeted mechanism of action. Appendix Figures for Traumeel ointment vs diclofenac gel Traumeel gel vs diclofenac gel Efficacy Claim – Reducing Pain Traumeel Ointment vs. Diclofenac Traumeel is as effective as NSAIDs in reducing pain Traumeel ointment (O) N = 143 % median change in VAS score of ankle pain 0 Day 4 Day 7 Diclofenac gel (D) N = 137 Day 14 Day 42 -20 -40 O vs. D: p=0.5069 G vs. D: p=0.1131 -60 -80 -100 O vs. D: p=0.8205 G vs. D: p=0.3422 Primary efficacy endpoint: percentage change from baseline at day 7 O vs. D: p=0.7312 G vs. D: p=0.7640 O vs. D: p=0.9267 G vs. D: p=0.8314 Efficacy Claim – Reducing Pain Traumeel Gel vs. Diclofenac Traumeel is as effective as NSAIDs in reducing pain Traumeel gel (G) N = 140 % median change in VAS score of ankle pain 0 Day 4 Diclofenac gel (D) N = 137 Day 7 Day 14 Day 42 -20 -40 O vs. D: p=0.5069 G vs. D: p=0.1131 -60 -80 -100 O vs. D: p=0.8205 G vs. D: p=0.3422 Primary efficacy endpoint: percentage change from baseline at day 7 O vs. D: p=0.7312 G vs. D: p=0.7640 O vs. D: p=0.9267 G vs. D: p=0.8314 Efficacy Claim – Reducing Pain Traumeel Ointment vs. Diclofenac Traumeel is as effective as NSAIDs in reducing pain Traumeel ointment N = 143 Diclofenac gel N = 137 Median VAS score of ankle pain 60 50 40 30 20 10 0 Baseline Day 4 Day 7 Day 14 A patient’s assessment of ankle pain was performed using a 100 mm VAS (0=no pain; 100=worst pain imaginable) Day 42 Efficacy Claim – Reducing Pain Traumeel Gel vs. Diclofenac Traumeel is as effective as NSAIDs in reducing pain Traumeel gel N = 140 Diclofenac gel N = 137 Median VAS score of ankle pain 60 50 40 30 20 10 0 Baseline Day 4 Day 7 Day 14 A patient’s assessment of ankle pain was performed using a 100 mm VAS (0=no pain; 100=worst pain imaginable) Day 42 Efficacy Claim – Improving Function Traumeel Ointment vs. Diclofenac Traumeel is as effective as NSAIDs in improving function Traumeel ointment N = 143 Diclofenac gel N = 137 Median change from baseline in ADL subscale score 60 O vs. D: p=0.4030 G vs. D: p=0.7588 50 O vs. D: p=0.4963 G vs. D: p=0.6665 40 O vs. D: p=0.3155 G vs. D: p=0.1584 30 20 O vs. D: p=0.6234 G vs. D: p=0.5350 10 0 Day 4 Day 7 Day 14 Higher scores represent higher levels of physical function Day 42 Efficacy Claim – Improving Function Traumeel Gel vs. Diclofenac Traumeel is as effective as NSAIDs in improving function Traumeel gel N = 140 Diclofenac gel N = 137 Median change from baseline in ADL subscale score 60 O vs. D: p=0.4030 G vs. D: p=0.7588 50 O vs. D: p=0.4963 G vs. D: p=0.6665 40 O vs. D: p=0.3155 G vs. D: p=0.1584 30 20 O vs. D: p=0.6234 G vs. D: p=0.5350 10 0 Day 4 Day 7 Day 14 Higher scores represent higher levels of physical function Day 42 Efficacy Claim – Improving Function Traumeel Ointment vs. Diclofenac Traumeel is as effective as NSAIDs in improving function Traumeel ointment N = 143 Diclofenac gel N = 137 Median ADL subscale score 100 80 60 40 20 0 Baseline Day 4 0=worst level of physical function, 100=highest level of physical function Day 7 Day 14 Day 42 Efficacy Claim – Improving Function Traumeel Gel vs. Diclofenac Traumeel is as effective as NSAIDs in improving function Traumeel gel N = 140 Diclofenac gel N = 137 Median ADL subscale score 100 80 60 40 20 0 Baseline Day 4 0=worst level of physical function, 100=highest level of physical function Day 7 Day 14 Day 42 Efficacy Claim – Secondary Efficacy Variable: Swelling – Traumeel Ointment vs. Diclofenac Swelling was reduced from baseline in all groups at all time points 0 Day 7 Day 14 Day 14 Median changes in swelling ‘figure-of-eight’ (cm) -0.1 -0.2 -0.3 O vs.. D: p=0.5096 G vs. D: p=0.2236 -0.4 -0.5 O vs. D: p=0.3895 G vs. D: p=0.2000 -0.6 -0.7 O vs. D: p=0.1454 G vs. D: p=0.1295 -0.8 Traumeel ointment (O) N = 143 Diclofenac gel (D) N = 137 Greater changes represent greater improvement (reduced swelling Efficacy Claim – Secondary Efficacy Variable: Swelling – Traumeel Gel vs. Diclofenac Swelling was reduced from baseline in all groups at all time points 0 Day 7 Day 14 Day 14 Median changes in swelling ‘figure-of-eight’ (cm) -0.1 -0.2 -0.3 O vs.. D: p=0.5096 G vs. D: p=0.2236 -0.4 -0.5 O vs. D: p=0.3895 G vs. D: p=0.2000 -0.6 -0.7 O vs. D: p=0.1454 G vs. D: p=0.1295 -0.8 Traumeel gel (G) N = 140 Diclofenac gel (D) N = 137 Greater changes represent greater improvement (reduced swelling