Nsaids for oa of hip and knee

STUDY HIGHLIGHTS

• Researchers searched for RCTs of NSAIDs, acetaminophen, and placebo for the treatment of OA of the hip and knee. Only trials with at least 100 participants were included in the meta-analysis.
• Researchers searched for published and unpublished data available before February 24, 2015.
• The main outcome of the network meta-analysis was pain, and researchers also evaluated NSAIDs in their effects on function.
• From a total of 8973 reports, 74 trials with a total of 58,556 patients were included in the meta-analysis.
• Celecoxib 200 mg/day was the most commonly studied treatment, followed by naproxen 1000 mg/day. In contrast, relatively few patients participated in trials of diclofenac 70 mg/day and etoricoxib 90 mg/day.
• The collective research was generally at low risk for bias, except for the specific bias of incomplete outcome data.
• Most trials were less than 3 months in duration, but there was no evidence that the length of treatment affected analgesic efficacy.
• Insufficient data were available to demonstrate a statistically significant reduction in pain vs placebo for the following treatments:
  • Acetaminophen less than 2000 mg/day and 3000 mg/day
  • Diclofenac 70 mg/day
  • Naproxen 750 mg/day
  • Ibuprofen 1200 mg/day
• In contrast, reductions in pain judged clinically significant by the authors vs placebo were noted for the following medications:
  • Diclofenac 150 mg/day
  • Etoricoxib 30 mg/day, 60 mg/day, and 90 mg/day
  • Rofecoxib 25 mg/day and 50 mg/day
• The difference between ineffective treatment and the most effective treatment as judged by the study authors was approximately 10 mm on a 100-mm pain scale.
• In general, higher doses of NSAIDs were more effective in relieving pain. This trend was most remarkable for celecoxib, diclofenac, and naproxen.
• Data regarding the treatment effect on physical function mirrored that for pain. A clinically significant effect was noted for diclofenac 150 mg/day and rofecoxib 25 mg/day.
• The researchers conclude that diclofenac 150 mg/day appears to be the most effective NSAID for OA.