Comparative Efficacy And Safety Of Non-steroidal Anti-inflammatory Drugs In Patients With Juvenile Idiopathic Arthritis:A Network Meta-analysis

Objective: We conducted a network meta-analysis to compare and evaluate the efficacy and safety of nine non-steroidal anti-inflammatory drugs(NSAIDs)in treating patients with juvenile idiopathic arthritis(JIA).Methods: Randomized controlled trials(RCTs)of NSAIDs for the treatment in children with JIA were searched systematically by using Pubmed,EMBASE,and the Cochrane Library for available literatures up to January 1,2019.Bayesian network meta-analysis was used to combine direct and indirect evidences on treatment effectiveness and safety.Result: Eight eligible studies involving 1112 patients with JIA were identified,including nine interventions.The ranking probability plot based on the surface under the cumulative raking curve(SUCRA)indicated that celecoxib(6mg/kg bid)had the highest probability of being the most effective treatment(SUCRA = 76.4%)of the 4 kinds of NSAIDs(celecoxib,rofecoxib,meloxicam and naproxen).As for adverse reaction,rofecoxib(0.3mg/kg qd)and piroxicam demonstrated there more safety in treating children with JIA(SUCRA = 33.0%,35.5%,respectively),compared with other interventions.Conclusion: This comprehensive systematic review and meta-analysis on efficacy and safety of NSAIDs in JIA patients highlights that celecoxib,rofecoxib,and piroxicam with once-daily dosing schedules may have the better efficacy and safety.However,the quality of available evidence limit strong conclusions about the comparative efficacy or safety of NSAIDs used to treat JIA.More large-scale and well-designed RCTs are still warranted due to the limitations of present studies.