Institute of Rheumatology and Clinic of Rheumatology, Charles University, Prague, Czech Republic.
Curr Med Res Opin. 2012 Jan;28(1):163-78. doi: 10.1185/03007995.2011.649848.
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) commonly prescribed for pain relief in osteoarthritis (OA). The relative efficacy of diclofenac compared to other pain relief medications used in OA (e.g., alternative NSAIDs, cyclooxygenase type 2 [COX-2] inhibitors) is uncertain. The objective of this systematic review is to compare the current evidence on efficacy of diclofenac versus other pain relief medications.
A systematic literature search was carried out for randomised, well controlled clinical trials comparing the efficacy of diclofenac with other pain relief medications in OA (reviews, meta-analyses and n = 1 trials were excluded). The databases searched were EMBASE, Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, and Ovid MEDLINE Daily Update. Articles were included from 1999 onwards. Retrieved articles were discussed by comparator medication.
Of the 263 articles identified in the literature search, 37 were eventually included in this review. These were comparisons with the selective COX-2 inhibitors etoricoxib, celecoxib, lumiracoxib and rofecoxib; comparisons with the NSAIDs aceclofenac, dexketoprofen, etodolac, lornoxicam, meloxicam, nabumetone and nimesulide; and comparisons to acetaminophen, tramadol, diacerein, oxaceprol, oral hydrolytic enzyme therapies, Chinese herbal remedies and castor oil supplementation. Overall, in the majority of the trials at therapeutic doses diclofenac provided similar efficacy to comparator treatments; and in general diclofenac was able to support its position as a reference medication of choice for OA trials.
The efficacy of diclofenac is largely unchallenged in that it remains as effective as newer pain relief medications employed in OA. A review of the available data demonstrates that diclofenac continues to provide physicians with a benchmark pharmacological treatment for OA.
双氯芬酸是一种常用于治疗骨关节炎（OA）疼痛的非甾体抗炎药（NSAID）。与 OA 中使用的其他止痛药物（例如，替代 NSAIDs、环氧化酶 2 [COX-2]抑制剂）相比，双氯芬酸的相对疗效尚不确定。本系统评价的目的是比较双氯芬酸与其他止痛药物疗效的现有证据。
进行了系统的文献检索，以查找比较双氯芬酸与 OA 中其他止痛药物疗效的随机、对照临床试验（排除综述、荟萃分析和 n=1 试验）。检索的数据库包括 EMBASE、Ovid MEDLINE、Ovid MEDLINE In-Process 和其他非索引引文以及 Ovid MEDLINE Daily Update。从 1999 年开始收录文章。讨论了由比较药物检索到的文章。
在文献检索中确定了 263 篇文章，最终有 37 篇文章纳入本综述。这些比较包括与选择性 COX-2 抑制剂依托考昔、塞来昔布、鲁米昔布和罗非昔布的比较；与 NSAIDs 依托芬那酯、双氯芬酸、依托度酸、氯诺昔康、美洛昔康、那布美酮和尼美舒利的比较；以及与对乙酰氨基酚、曲马多、二乙酰氨己酸、奥沙普秦、口服水解酶治疗、中药和蓖麻油补充剂的比较。总体而言，在大多数治疗剂量的试验中，双氯芬酸与对照治疗的疗效相似；而且一般来说，双氯芬酸能够支持其作为 OA 试验首选参考药物的地位。
双氯芬酸的疗效在很大程度上没有受到挑战，因为它与 OA 中使用的新型止痛药物一样有效。对现有数据的回顾表明，双氯芬酸继续为医生提供 OA 的基准药物治疗。
