| Objective:To evaluate the efficacy and safety of etoricoxib versus celecoxib in the treatment of osteoarthritis(OA).Methods: We included randomized controlled trials(RCTs)comparing etoricoxib with celecoxib for OA.The participants were patients with hip/knee OA.The primary outcomes were WOMAC score(including pain,function and stiffness,0-100).The secondary outcomes were PGADS(Patient Global Assessment of Disease Status,0-100),IGADS(Investigator Global Assessment of Disease Status,0-4),ISOA(Index of Severity for Osteoarthritis,0-24),etc.We searched the PUBMED,CENTRAL,EMBASE,CBM(all up to December 28,2016),etc,and evaluated the risk of bias.Two reviewers independently identified the included trials and extracted data.The Review manager 5.3 software was used for data analysis.Continuous data were pooled together,using weighted mean difference(MD)or standard mean difference(SMD)(according to data comparability)and 95% confidence interval(CI)and dichotomous data using the relative risk(RR)and 95%CI.Results:Fiveoriginal RCTs were included in this systematic review.The sample size ranged from 120 to 491 with a total number of 1482 patients,of which 481 were males and 1001 were females,1271 were knee OA and 211 were hip OA.The overall risk of bias was low in 3 trials and high in 2 trials.The results were showed as follows:(1)WOMAC score: 3 RCTs(n=1202,including 344 males and 858 females,991 knee OA and 211 hip OA)reported WOMAC score.All these 3 RCTs compared 30mg/d etoricoxib with 200mg/d celecoxib.Pain and function WOMAC score was reported as change from baseline.Pooled MDs were-1.74(-3.90,0.43)and-1.12(-3.29,1.04),respectively.One RCT(n=239)reported WOMAC score change from baseline in stiffness.MD was-0.86(-4.98,3.26).Both the three individual trials and the summarized result showed etoricoxib had slightly lower WOMAC than celecoxib group but the differences were not statistically significant.(2)PGADS(change from baseline): 3 RCTs(n=1202,including 344 males and 858 females,991 knee OA and 211 hip OA)reported PGADS.All these 3 RCTs compared 30mg/d etoricoxib with 200mg/d celecoxib.Pooled MD was-2.65(-4.91,-0.39).Althoughstatistically significant,the difference was marginal and make little clinical sense.(3)IGADS(change from baseline): 3 RCTs(n=1202,including 344 males and 858 females,991 knee OA and 211 hip OA)reported IGADS.All these 3 RCTs compared 30mg/d etoricoxib with 200mg/d celecoxib.The pooled MD was-0.07(-0.21,0.07),which showed no difference between etoricoxib and celecoxib group.(4)ISOA: 2 RCTs(including 280 knee OA with 137 males and 143 females)reported ISOA.Both RCTs compared 120mg/d etoricoxib with 200mg/d or 400mg/d celecoxib.The pooled result showed ISOA in etoricoxib group was significantly lower than that in celecoxib group.MDwas-4.27(-5.15,-3.39).(5)Safety outcomes: There was no statistically significant difference between etoricoxib and celecoxib group in drug-related adverse events,withdrawals for adverse events and all withdrawals from study.RRs were 1.16(0.88,1.53),1.13(0.63,2.03)and 0.92(0.69,1.24),respectively.Conclusions:(1)Compared with 200mg/dcelecoxib,30mg/d etoricoxibhad equivalent efficacy for hip/knee OA in improving WOMAC score,PGADS and IGADS.(2)For ISOA outcome in knee OA,120mg/d etoricoxib wassignificantly superior to200mg/d or 400mg/d celecoxib.(3)Both of etoricoxib and celecoxib were generally safe and well tolerated. |
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