Towheed T E, Hochberg M C, Shea B J, Wells G
Queen's University, Medicine and of Community Health and Epidemiology, Etherington Hall-Room 2066, Kingston, Ontario, Canada, K7L 3N6.
Cochrane Database Syst Rev. 2007 Jul 18(1):CD000517. doi: 10.1002/14651858.CD000517.pub2.
Non-steroidal anti-inflammatory drugs (NSAIDs) have been widely used as a pharmacologic treatment to relieve pain for patients with OA of the hip. However, these agents are associated with significant toxicity, particularly in the elderly population (age > 65 years).
To review all randomized trials of analgesics and anti-inflammatory therapy in osteoarthritis (OA) of the hip. To determine which non-steroidal, anti-inflammatory drug (NSAID) is the most effective, and which NSAID is the most toxic.
We searched the Cochrane Musculoskeletal Group's trials register, the Cochrane Controlled Trials Register and MEDLINE up to August 1994. Reference lists of all trials were also manually searched.
All randomized controlled trials comparing non-steroidal anti-inflammatory drugs (NSAIDs) and/or analgesics in patients with Osteoarthritis. The trials selected for inclusion were identified by one reviewer (TT) and rechecked by a second (MH).
Qualitative assessments were performed using a quality scoring system designed for NSAID trials in rheumatoid arthritis. Both the design and analysis aspects of the trials were evaluated, each aspect being rated on a scale of 0 to 8. A quantitative method, which calculates the ratio of improvement produced by one NSAID to that produced by another, was used to rate the relative efficacy of different NSAIDs with respect to pain relief. Toxicity comparisons were made according to the reviewer findings. All quality assessments were carried out independently by two reviewers (TT, BS). All data abstraction was carried out by one reviewer (TT) and rechecked by two other reviewers (BS, GW). A consensus was reached on discrepancies.
Forty-three trials were identified, and of these, 39 evaluated NSAIDs, while four evaluated only analgesics. The median design and analysis scores were two and four respectively. Six NSAIDs were included in at least five trials. Of these, indomethacin was rated more effective in five of its seven comparisons, but more toxic in seven of 12 comparisons. Only five of the 29 (17%) NSAID comparisons found statistically significant differences in efficacy. Of the 43 RCTs identified only 17 had statistical data available for future pooling for this meta-analysis. In the case where data was missing, authors of the trials will be contacted for inclusion of data in future reviews.
AUTHORS' CONCLUSIONS: NSAID trials in patients with OA of the hip appear to be weakened by the lack of standardization of case definition of OA, and also by the lack of standardization of outcome assessments. No clear recommendations for the choice of specific NSAID therapy in hip OA can be offered at this time based on this analysis.
非甾体抗炎药（NSAIDs）已被广泛用作缓解髋骨关节炎（OA）患者疼痛的药物治疗方法。然而，这些药物具有显著的毒性，尤其是在老年人群（年龄>65岁）中。
回顾所有关于髋骨关节炎（OA）镇痛和抗炎治疗的随机试验。确定哪种非甾体抗炎药（NSAID）最有效，哪种NSAID毒性最大。
我们检索了Cochrane肌肉骨骼组试验注册库、Cochrane对照试验注册库以及截至1994年8月的MEDLINE。还手动检索了所有试验的参考文献列表。
所有比较非甾体抗炎药（NSAIDs）和/或镇痛药治疗骨关节炎患者的随机对照试验。入选的试验由一位审阅者（TT）确定，并由另一位审阅者（MH）重新检查。
使用为类风湿关节炎NSAID试验设计的质量评分系统进行定性评估。对试验的设计和分析方面都进行了评估，每个方面的评分范围为0至8分。采用一种定量方法来评估不同NSAIDs在缓解疼痛方面的相对疗效，该方法计算一种NSAID产生的改善与另一种NSAID产生的改善之比。根据审阅者的发现进行毒性比较。所有质量评估均由两位审阅者（TT，BS）独立进行。所有数据提取由一位审阅者（TT）完成，并由另外两位审阅者（BS，GW）重新检查。对差异达成了共识。
共识别出43项试验，其中39项评估了NSAIDs，4项仅评估了镇痛药。设计和分析评分的中位数分别为2分和4分。六种NSAIDs至少在五项试验中被纳入。其中，吲哚美辛在其七项比较中的五项中被评为更有效，但在12项比较中的七项中被评为毒性更大。在29项NSAID比较中，只有5项在疗效上发现有统计学显著差异。在识别出的43项随机对照试验中，只有17项有可供本次荟萃分析未来合并的统计数据。在数据缺失的情况下，将联系试验作者以便在未来的综述中纳入数据。
髋骨关节炎患者的NSAID试验似乎因OA病例定义缺乏标准化以及结局评估缺乏标准化而受到削弱。基于本次分析，目前无法为髋骨关节炎的特定NSAID治疗选择提供明确建议。
