Knee osteoarthritis: efficacy and adverse events trajectory of oral NSAIDs

  • Osani MC & al.
  • Arthritis Care Res (Hoboken)
  • 25 Mar 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • Oral non-steroidal anti-inflammatory drugs (NSAIDs) provide statistically significant pain reduction and functional improvement in knee osteoarthritis that peaks at 2 weeks, but the effects begin to decline by 8 weeks.
  • Incidence of minor gastrointestinal (GI) and cardiovascular (CV) adverse events (AEs) were evident from 4 weeks of exposure.

Why this matters

  • This information regarding the trajectory of efficacy and early AEs of oral NSAIDs can aid clinicians in selecting an appropriate NSAID treatment regimen.

Study design

  • Meta-analysis of 72 randomised controlled trials (RCTs; n=26,424) from 2 to 26 weeks to characterise the trajectory of efficacy and early AEs for oral NSAIDs in knee osteoarthritis.
  • Oral NSAIDs assessed (number of RCTs): celecoxib (35), naproxen (18), diclofenac (11), nabumetone (7), ibuprofen (6), meloxicam (3), etodolac (2), indomethacin (1) and piroxicam (1).
  • Funding: None disclosed.

Key results

  • NSAIDs showed statistically significant effects on pain as early as 2 weeks from baseline (standardised mean difference [SMD], −0.43; 95% CI, −0.48 to −0.38).
  • Treatment effect remained statistically significant up to 26 weeks (SMD, −0.21; 95% CI, −0.39 to −0.03), although the effects decreased progressively over time.
  • NSAIDs demonstrated consistent statistically significant benefits with respect to functional improvement from 2 (SMD, −0.45; 95% CI, −0.52 to −0.38) to 26 weeks (SMD, −0.19; 95% CI, −0.32 to −0.07)
  • Patients receiving NSAIDs were more likely to experience GI AE as early as 4 weeks after treatment (risk ratio, 1.38; 95% CI, 1.21-1.57).
  • The incidence of CV AEs did not differ significantly between NSAID and placebo.
  • Majority of GI and CV AEs collected were transient and of minor severity

Limitations

  • No separate analyses of the studies utilising the individual drugs’ highest recommended dose.
  • No data at and beyond the 26-week time point.

Please confirm your acceptance

To gain full access to GPnotebook please confirm:

By submitting here you confirm that you have accepted Terms of Use and Privacy Policy of GPnotebook.

Submit