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The low quality of evidence suggests the superior effectiveness of
celecoxib over placebo and few traditional NSAIDs. Future studies are needed to
understand the role of celecoxib in OA management better.
Lately, a study demonstrated that celecoxib is somewhat better than placebo and some traditional NSAIDs (tNSAIDs) in decreasing osteoarthritic pain and enhancing physical function.
Osteoarthritis (OA), one of the most prevalent forms of arthritis is associated with extreme disability and impaired quality of life. It is caused due to degeneration of the joint cartilage and growth of new bone, cartilage, and connective tissue. Scientists are trying hard to find out the best treatment for OA. Celecoxib, a selective NSAID, looks promising in providing effective relief from osteoarthritic Pain.
A review study was conducted to evaluate the clinical benefits and safety of Celecoxib. Researchers searched MEDLINE, Embase, CENTRAL and clinical trials register up to April 11, 2017. They searched reference and citation lists of included studies as well. Researchers also approached pharmaceutical companies and authors of the published articles. The articles involved in the analysis were comparison studies of oral celecoxib versus no intervention, placebo or another tNSAID among patients having OA. The included articles were published between 1999 and 2014. Most of the participants involved in the study were white women with a mean age of 62. The extraction of data, quality estimation and comparison of results were done by two authors independently. The patient-reported outcomes of pain and physical function evaluation were operated on studies including low risk of bias for allocation concealment, sequence generation, and double blinding.
A total of 36 trials were involved in the analysis, which comprised about 17,206 participants. Out of 17,206 participants, 9402 received 200 mg celecoxib per day, and the remaining 7804 received either placebo or tNSAIDs. The comparison of Celecoxib with placebo, diclofenac, and naproxen was also studied. There was no risk of bias for performance and detection bias. Although, selection bias was noted among most of the trials. Many trials involved high attrition bias as well.
In comparison to placebo, celecoxib reduced pain as evaluated on a 500-point Western Ontario and WOMAC pain scale, accounting for 12% relative improvement and 3% absolute improvement. Also, celecoxib depicted a slight improvement in physical function as measured through 1700-point WOMAC scale accounting for 12% relative improvement and 4% absolute improvement with no clinical significance.
The
results in case of serious AEs, cardiovascular events and gastrointestinal
events among participants were uncertain. Although, regulatory agencies have
warned about enhanced cardiovascular events with celecoxib. The results
regarding the effect of celecoxib on pain as compared to tNSAIDs were not
conclusive as evaluated on 100-point VAS, reflecting 11% relative improvement
or 5% absolute improvement. However, a slight improvement was noted in physical
function compared to tNSAID as measured on a 100-point WOMAC scale reflecting
16% relative improvement and 6% absolute improvement. There was low-quality
evidence for withdrawals. Further, in celecoxib and placebo comparison, no
difference was seen in pooled analyses between the main analysis at little risk
of bias and all accepted studies. In celecoxib and tNSAIDs comparison,
only physical function showed difference among studies at low risk of bias and
all eligible studies. No study was included in the main comparisons that measured
the quality of life.
Cochrane Database Syst Rev. 2017 May 22;5: CD009865
Celecoxib for osteoarthritis
Puljak L et al.
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