PT  - JOURNAL ARTICLE
AU  - Mengtao Li
AU  - Chen Yu
AU  - Xiaofeng Zeng
TI  - Comparative efficacy of traditional non-selective NSAIDs and selective cyclo-oxygenase-2 inhibitors in patients with acute gout: a systematic review and meta-analysis
AID  - 10.1136/bmjopen-2019-036748
DP  - 2020 Sep 01
TA  - BMJ Open
PG  - e036748
VI  - 10
IP  - 9
4099  - http://bmjopen.bmj.com/content/10/9/e036748.short
4100  - http://bmjopen.bmj.com/content/10/9/e036748.full
SO  - BMJ Open2020 Sep 01; 10
AB  - 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.