Department of General Practice, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
Osteoarthritis Cartilage. 2011 Aug;19(8):921-9. doi: 10.1016/j.joca.2011.04.013. Epub 2011 May 12.
To identify sources of heterogeneity (statistical, methodological, and clinical) in studies evaluating non-steroidal anti-inflammatory drugs (NSAIDs) vs acetaminophen in patients with knee and hip osteoarthritis (OA) to elucidate variations in outcomes.
A database search (1966 to January 2010) was made for (randomized) controlled trials ((R)CTs) comparing NSAIDs vs acetaminophen in knee and hip OA. Extracted data included baseline demographic/clinical characteristics, outcomes at follow-up, and characteristics of study design. Heterogeneity was examined with subgroup analyses by exploring changes in effect size and with I(2) of Higgins. Pain measures were expressed as standardized mean differences.
15 RCTs, including 21 comparisons of NSAIDs and acetaminophen were included. Statistical heterogeneity was absent (Cochran's Q-test=14.11; I(2)=0; P=0.78). Moderate clinical heterogeneity was found for comparisons which included both hip and knee OA vs knee OA only (I(2)=51; P=0.09). NSAIDs seemed slightly more effective than acetaminophen if more patients with hip OA were included. However, the pooled effect sizes of comparisons with knee OA vs both knee and hip OA are equal. Low clinical heterogeneity was found for comparisons with low dosage of acetaminophen, normal dosage of NSAIDs, and moderate pain intensity at baseline. Low methodological heterogeneity was found for comparisons with a short duration.
Future trials should present the results of hip and knee OA separately, as moderate clinical heterogeneity was found. There might be differences in effectiveness of NSAIDs vs acetaminophen in patients with hip vs knee OA. No significant methodological and statistical heterogeneity was found in studies evaluating NSAIDs vs acetaminophen.
确定评估膝关节和髋关节骨关节炎（OA）患者中 NSAIDs 与对乙酰氨基酚的疗效的研究中（统计学、方法学和临床）异质性的来源，以阐明结局的差异。
对数据库（1966 年至 2010 年 1 月）进行检索，查找比较 NSAIDs 与对乙酰氨基酚治疗膝关节和髋关节 OA 的（随机）对照试验（RCT）。提取的数据包括基线人口统计学/临床特征、随访时的结局以及研究设计的特征。通过亚组分析，通过探索效应大小的变化和 Higgins 的 I²来检查异质性。疼痛测量以标准化均数差值表示。
共纳入 15 项 RCT，包括 21 项 NSAIDs 与对乙酰氨基酚的比较。未发现统计学异质性（Cochran's Q 检验=14.11；I²=0；P=0.78）。对于包括髋关节和膝关节 OA 与仅膝关节 OA 的比较，发现存在中度临床异质性（I²=51；P=0.09）。如果包括更多髋关节 OA 患者，NSAIDs 似乎比对乙酰氨基酚更有效。然而，与膝关节 OA 相比，与膝关节和髋关节 OA 相比的 pooled 效应大小相等。对于低剂量对乙酰氨基酚、正常剂量 NSAIDs 和基线时中度疼痛强度的比较，发现临床异质性较低。对于持续时间较短的比较，发现方法学异质性较低。
未来的试验应分别报告髋关节和膝关节 OA 的结果，因为发现了中度临床异质性。在髋关节 OA 与膝关节 OA 患者中，NSAIDs 与对乙酰氨基酚的疗效可能存在差异。在评估 NSAIDs 与对乙酰氨基酚的研究中，未发现明显的方法学和统计学异质性。
