Stam Wb, Jansen Jp, Taylor Sd
Mapi Group, Houten, The Netherlands.
Open Rheumatol J. 2012;6:6-20. doi: 10.2174/1874312901206010006. Epub 2012 Apr 3.
To compare the efficacy of etoricoxib, lumiracoxib, celecoxib, non-selective (ns) NSAIDs and acetaminophen in the treatment of osteoarthritis (OA) METHODS: Randomized placebo controlled trials investigating the effects of acetaminophen 4000mg, diclofenac 150mg, naproxen 1000mg, ibuprofen 2400mg, celecoxib 100-400mg, lumiracoxib 100-400mg, and etoricoxib 30-60mg with treatment duration of at least two weeks were identified with a systematic literature search. The endpoints of interest were pain, physical function and patient global assessment of disease status (PGADS). Pain and physical function reported on different scales (VAS or LIKERT) were translated into effect sizes (ES). An ES 0.2 - 0.5 was defined as a "small" treatment effect, whereas ES of 0.5 - 0.8 and > 0.8 were defined as "moderate" and "large", respectively. A negative effect indicated superior effects of the treatment group compared to the control group. Results of all trials were analyzed simultaneously with a Bayesian mixed treatment comparison.
There is a >95% probability that etoricoxib (30 or 60mg) shows the greatest improvement in pain and physical function of all interventions compared. ESs of etoricoxib 30mg relative to placebo, celecoxib 200mg, ibuprofen 2400mg, and diclofenac 150mg were -0.66 (95% Credible Interval -0.83; -0.49), -0.32 (-0.50; -0.14), -0.25 (-0.53; 0.03), and -0.17 (-0.41; 0.08), respectively. Regarding physical functioning, ESs of etoricoxib 30mg relative to placebo, celecoxib 200mg, ibuprofen 2400mg, and diclofenac 150mg were -0.61 (-0.76; -0.46), -0.27 (-0.43; -0.10), -0.20 (-0.47; 0.07), and -0.09 (- 0.33; 0.14) respectively. The greatest improvements in PGADS were expected with either etoricoxib or diclofenac.
The current study estimated the efficacy of acetaminophen, nsNSAIDs, and COX-2 selective NSAIDs in OA and found that etoricoxib 30 mg is likely to result in the greatest improvements in pain and physical function. Differences in PGADS between interventions were smaller.
比较依托考昔、鲁米昔布、塞来昔布、非选择性（ns）非甾体抗炎药（NSAIDs）和对乙酰氨基酚治疗骨关节炎（OA）的疗效。
通过系统文献检索，确定了研究4000mg对乙酰氨基酚、150mg双氯芬酸、1000mg萘普生、2400mg布洛芬、100 - 400mg塞来昔布、100 - 400mg鲁米昔布和30 - 60mg依托考昔，治疗持续时间至少两周的随机安慰剂对照试验。感兴趣的终点为疼痛、身体功能和患者对疾病状态的整体评估（PGADS）。不同量表（视觉模拟评分法或李克特量表）报告的疼痛和身体功能转化为效应量（ES）。ES为0.2 - 0.5被定义为“小”治疗效果，而ES为0.5 - 0.8和> 0.8分别被定义为“中等”和“大”。负效应表明治疗组相对于对照组有更好的效果。所有试验结果采用贝叶斯混合治疗比较法同时进行分析。
依托考昔（30或60mg）在所有比较的干预措施中，疼痛和身体功能改善最大的概率>95%。依托考昔30mg相对于安慰剂、200mg塞来昔布、2400mg布洛芬和150mg双氯芬酸的ES分别为 - 0.66（95%可信区间 - 0.83； - 0.49）、 - 0.32（ - 0.50； - 0.14）、 - 0.25（ - 0.53；0.03）和 - 0.17（ - 0.41；0.08）。关于身体功能，依托考昔30mg相对于安慰剂、200mg塞来昔布、2400mg布洛芬和150mg双氯芬酸的ES分别为 - 0.61（ - 0.76； - 0.46）、 - 0.27（ - 0.43； - 0.10）、 - 0.20（ - 0.47；0.07）和 - 0.09（ - 0.33；0.14）。PGADS改善最大的预期药物为依托考昔或双氯芬酸。
本研究评估了对乙酰氨基酚、nsNSAIDs和COX - 2选择性NSAIDs在OA中的疗效，发现30mg依托考昔可能在疼痛和身体功能方面带来最大改善。各干预措施在PGADS上的差异较小。
