Objective To assess the comparative efficacy of traditional non-steroidal anti-inflammatory drugs (NSAIDs) and selective cyclo-oxygenase-2 inhibitors in patients with acute gout.
Design Systematic review and meta-analysis.
Data sources Medline, Web of Science, China National Knowledge Infrastructure and Wanfang Data published as of 4 April 2020.
Methods We performed meta-analysis of randomised controlled trials (RCTs) of traditional non-selective NSAIDs versus cyclo-oxygenase-2 inhibitors and RCTs of various cyclo-oxygenase-2 inhibitors in patients with acute gout. The main outcome measures were mean change in pain Visual Analogue Scale (VAS) score and 5-point Likert scale score on days 2–8.
Results Twenty-four trials involving five drugs were evaluated. For pain Likert scale, etoricoxib was comparable to indomethacin (standardised mean difference (SMD): −0.09, 95% CI: −0.27 to 0.08) but better than diclofenac 50 mg three times a day (SMD: −0.53, 95% CI: −0.98 to 0.09). Regarding pain VAS score, etoricoxib was comparable to diclofenac 75 mg two times per day (SMD: −1.63, 95% CI: −4.60 to 1.34) and diclofenac 75 mg one time a day (SMD: −1.82, 95% CI: −5.18 to 1.53), while celecoxib was comparable to diclofenac 100 mg one time a day (SMD: −2.41, 95% CI: −5.91 to 1.09). Etoricoxib showed similar patients’ global assessment of response (SMD: −0.10, 95% CI: −0.27 to 0.07) and swollen joint count (SMD: −0.25, 95% CI: −0.74 to 0.24), but better investigator’s global assessment of response (SMD: −0.29, 95% CI: −0.46 to 0.11) compared with indomethacin. Etoricoxib showed more favourable pain VAS score than celecoxib (SMD: −2.36, 95% CI: −3.36 to 1.37), but was comparable to meloxicam (SMD: −4.02, 95% CI: −10.28 to 2.24). Etoricoxib showed more favourable pain Likert scale than meloxicam (SMD: −0.56, 95% CI: −1.10 to 0.02). Etoricoxib 120 mg one time a day was more likely to achieve clinical improvement than celecoxib 200 mg two times per day (OR: 4.84, 95% CI: 2.19 to 10.72).
Conclusion Although cyclo-oxygenase-2 inhibitors and traditional non-selective NSAIDs may be equally beneficial in terms of pain relief, cyclo-oxygenase-2 inhibitors (especially etoricoxib) may confer a greater benefit.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Statistics from Altmetric.com
Contributors ML, CY and XZ were responsible for the conception and design of the study. ML and CY did the analysis and interpreted the analysis. ML and CY wrote the first draft of the manuscript. All authors critically revised the manuscript and have approved the final version.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available on reasonable request. The data that support the findings of this study are available from the corresponding author, on reasonable request.
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.