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Relative efficacy and tolerability of etoricoxib, celecoxib, and naproxen in the treatment of osteoarthritis

A Bayesian network meta-analysis of randomized controlled trials based on patient withdrawal

Relative Wirksamkeit und Verträglichkeit von Etoricoxib, Celecoxib und Naproxen bei der Behandlung von Osteoarthritis

Eine bayessche Netzwerkmetaanalyse randomisiert-kontrollierter Studien auf Basis von Patientenausschlüssen

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Abstract

Aims

This study aimed to assess the relative efficacy and tolerability of etoricoxib, celecoxib, and naproxen at recommended dosages in patients with osteoarthritis (OA).

Methods

Randomized controlled trials (RCTs) examining the efficacy and tolerability of etoricoxib 30–60 mg, celecoxib 200–400 mg, and naproxen 1000 mg, based on the number of patient withdrawals among those with OA, were included in this network meta-analysis. We performed a Bayesian random-effects network meta-analysis to combine direct and indirect evidence from the RCTs.

Results

Eight RCTs, including 5,942 patients, met the inclusion criteria. The proportion of patient withdrawals due to lack of efficacy was significantly lower in the etoricoxib 30–60 mg (OR 0.21, 95 % CrI 0.12–0.38), celecoxib 200–400 mg (OR 0.29, 95 % CrI 0.18–0.47), and naproxen 1000 mg (OR 0.31, 95 % CrI 0.18–0.51) groups than in the placebo group. The number of patient withdrawals due to lack of efficacy tended to be lower in the etoricoxib 30–60 mg group than in the naproxen 1000 mg and celecoxib 200–400 mg groups, although they did not reach statistical significance (OR 0.68, 95 % CrI 0.36–1.33 and OR 0.70, 95 % CrI 0.38–1.37, respectively). Ranking probabilities based on the surface under the cumulative ranking curve (SUCRA) indicated that etoricoxib 30–60 mg had the highest probability of being the best treatment based on the number of withdrawals due to lack of efficacy (SUCRA = 0.9168) followed by celecoxib 200–400 mg (SUCRA = 0.5659), naproxen 1000 mg (SUCRA = 0.5171), and placebo (SUCRA = 0.000189). With respect to tolerability, the number of withdrawals due to adverse events was not significantly different among etoricoxib, celecoxib, naproxen, and placebo, although it tended to be lower with etoricoxib and placebo.

Conclusions

Etoricoxib 30–60 mg, celecoxib 200–400 mg, and naproxen 1000 mg were more efficacious than placebo. However, there was no significant difference in efficacy and tolerability between the medications.

Zusammenfassung

Ziele

Ziel dieser Studie ist es, die relative Wirksamkeit und Verträglichkeit von Etoricoxib, Celecoxib und Naproxen in den empfohlenen Dosierungen bei Patienten mit Osteoarthritis (OA) zu bewerten.

Methoden

Randomisiert-kontrollierte Studien (RCTs), die die Wirksamkeit und Verträglichkeit von Etoricoxib 30–60 mg, Celecoxib 200–400 mg und Naproxen 1000 mg untersucht haben, wurden auf Grundlage der Anzahl von Ausschlüssen unter Patienten mit OA in diese Netzwerkmetaanalyse einbezogen. Wir haben eine Netzwerkmetaanalyse nach bayesschen Random Effects durchgeführt, um die direkte und indirekte Evidenz von den RCTs zu kombinieren.

Ergebnisse

Acht RCTs mit 5942 Patienten haben die Einschlusskriterien erfüllt. Der Anteil von Patientenausschlüssen wegen mangelnder Wirksamkeit war in den Gruppen mit Etoricoxib 30–60 mg (OR 0,21, 95 % CrI 0,12–0,38), Celecoxib 200–400 mg (OR 0,29, 95 % CrI 0,18–0,47) und Naproxen 1000 mg (OR 0,31, 95 % CrI 0,18–0,51) signifikant niedriger als in der Placebogruppe. Die Anzahl von Patientenausschlüssen wegen mangelnder Wirksamkeit hatte in der Gruppe mit Etoricoxib 30–60 mg eine niedrigere Tendenz als in den Gruppen mit Naproxen 1000 mg und Celecoxib 200–400 mg, obwohl sie keine statistische Signifikanz erreichte (OR 0,68, 95 % CrI 0,36–1,33 bzw. OR 0,70, 95 % CrI 0,38–1,37). Die Ranking-Wahrscheinlichkeiten aufgrund der SUCRA („surface under the cumulative ranking curve“) zeigen, dass Etoricoxib 30–60 mg auf Grundlage der Zahl von Ausschlüssen wegen mangelnder Wirksamkeit (SUCRA = 0,9168) mit höchster Wahrscheinlichkeit die beste Behandlung ist, danach folgen Celecoxib 200–400 mg (SUCRA = 0,5659), Naproxen 1000 mg (SUCRA = 0,5171) und das Placebo (SUCRA = 0,000189). Hinsichtlich der Verträglichkeit war die Zahl der Ausschlüsse wegen Nebenwirkungen zwischen Etoricoxib, Celecoxib, Naproxen und Placebo nicht signifikant unterschiedlich, auch wenn sie bei Etoricoxib und beim Placebo eine niedrigere Tendenz hatte.

Schlussfolgerungen

Etoricoxib 30–60 mg, Celecoxib 200–400 mg und Naproxen 1000 mg waren wirksamer als das Placebo. Es gab jedoch keinen signifikanten Unterschied in der Wirksamkeit und Verträglichkeit zwischen den Medikamenten.

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Acknowledgements

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Division of Rheumatology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, 136-705, Seoul, South Korea

    Gwan Gyu Song, Young Ho Seo, Jae-Hoon Kim, Sung Jae Choi, Jong Dae Ji &  Young Ho Lee

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  1. Gwan Gyu Song
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Correspondence to Young Ho Lee.

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Conflict of interest

G.G. Song, Y.H. Seo, J.‑H. Kim, S.J. Choi, J.D. Ji and Y.H. Lee state that there are no conflicts of interest.

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Song, G.G., Seo, Y.H., Kim, JH. et al. Relative efficacy and tolerability of etoricoxib, celecoxib, and naproxen in the treatment of osteoarthritis . Z Rheumatol 75, 508–516 (2016). https://doi.org/10.1007/s00393-015-0023-9

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