Diclofenac 150mg per day was determined as the most effect non-steroidal anti-inflammatory drug (NSAID) available for improving both pain and function in patients with osteoarthritis, according to a study published in The Lancet.
A team of researchers from Switzerland aimed to study the efficacy of different formulations and doses of NSAIDs on osteoarthritis pain by conducting a network meta-analysis. They included randomized trials that compared any of the following treatments: NSAIDs, acetaminophen or placebo for the treatment of osteoarthritis pain. The prespecified primary and secondary outcomes were pain and physical function. In the primary analysis, a random walk of first order was used and treatments that used different total daily doses were considered separately in the analysis.
A total of 74 randomized trials including 58,556 patients were included for the analysis; 23 nodes regarding 7 different NSAIDs or acetaminophen with specific daily dose of administration or placebo were considered. All interventions, regardless of dose, showed improvement in pain symptoms when compared to placebo.
For diclofenac 150mg/day, etoricoxib 30mg/day, 60mg/day, and 90mg/day, and rofecoxib 25mg/day and 50mg/day, the probability that the difference to placebo was at or below a prespecified minimum clinically important effect for pain reduction (effect size [ES] −0.37) was at least 95%. Specifically, diclofenac 150mg/day (ES −0.57, 95% credibility interval [CrI]: −0.69 to −0.46) and etoricoxib 60mg/day (ES −0.58, 95% CrI: −0.73 to −0.43) showed the highest probability to be the most superior intervention, both with 100% probability to reach the minimum clinically important difference.
A higher dose corresponded to greater treatment effects only for celecoxib (P=0.030), diclofenac (P=0.031), and naproxen (P=0.026). Study authors noted no evidence that treatment effects fluctuated over the length of treatment.
Summary and Clinical Applicability
Researchers found no role for acetaminophen monotherapy for the treatment of patients with osteoarthritis regardless of dose. Among NSAIDs, Diclofenac 150mg/day was deemed the most effective in improving both pain and function.
da Costa BR, Reichenbach S, Keller N, et al. Effectiveness of non-steroidal anti-inflammatory drugs for the treatment of pain in knee and hip osteoarthritis: a network meta-analysis. Published Online Ahead of Print: 17 March 2016. DOI: http://dx.doi.org/10.1016/S0140-6736(16)30002-2.