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