Table 1:
Effects of NSAIDs on Pain and Function
| Outcome | All NSAIDs SMD (95% CI) | All NSAIDs- Very Low Quality* Removed | All NSAIDs- Knee OA only | Celecoxib | Intermediate COX Inhibitors | Traditional NSAIDs |
|---|---|---|---|---|---|---|
| Pain- all time points | ||||||
| N RCTs; N Patients | 48; 17,861 | 29; 11,741 | 32; 12,875 | 20; 7,996 | 9; 2,902 | 25; 7,303 |
| Pain- 2 weeks | −0.43 (−0.48, −0.38), I2= 55% | −0.48 (−0.55, −0.41), I2= 64% | −0.40 (−0.46, −0.35), I2= 44% | −0.41 (−0.48, −0.34), I2= 54% | −0.31 (−0.41, −0.21), I2= 40% | −0.51 (−0.59, −0.44), I2= 55% |
| N RCTs; N Patients | 59; 22,911 | 37; 15,287 | 41; 16,931 | 31; 11,699 | 9; 2,902† | 29; 8,896 |
| Pain- 4 weeks | −0.40 (−0.46, −0.34), I2= 76% | −0.40 (−0.44, −0.36), I2= 21% | −0.38 (−0.45, −0.30), I2= 80% | −0.34 (−0.39, −0.29), I2= 32% | −0.31 (−0.38, −0.23), I2= 0† | −0.44 (−0.54, −0.34), I2= 77% |
| N RCTs; N Patients | 13; 6,341 | 9; 4,648 | 6; 3,849 | 9; 4,970 | 1; 308 | 4; 1,218 |
| Pain- 8 weeks | −0.36 (−0.43, −0.30), I2= 41% | −0.42 (−0.49, −0.35), I2= 23% | −0.37 (−0.49, −0.26), I2= 69% | −0.37 (−0.46, −0.28), I2= 56% | −0.26 (−0.49, −0.04), I2= NA | −0.37 (−0.49, −0.25), I2= 0 |
| N RCTs; N Patients | 24; 11,096 | 17; 7,925 | 15; 7,762 | 13; 6,472 | 2; 571 | 13; 4,657 |
| Pain- 12 weeks | −0.30 (−0.34, −0.26), I2= 0 | −0.31 (−0.36, −0.27), I2= 0 | −0.27 (−0.32, −0.23), I2= 0 | −0.27 (−0.32, −0.22), I2= 0 | −0.25 (−0.41, −0.08), I2= 0 | −0.36 (−0.42, −0.30), I2= 0 |
| N RCTs; N Patients | 2; 976 | 2; 976 | 2; 976 | 2; 976 | ND | ND |
| Pain- 26 weeks | −0.21 (−0.39, −0.03), I2= 48% | −0.21 (−0.39, −0.03), I2= 48% | −0.21 (−0.39, −0.03), I2= 48% | −0.21 (−0.39, −0.03), I2= 48% | NA | NA |
| Function- all time points | ||||||
| N RCTs; N Patients | 28; 9,595 | 21; 7,317 | 15; 5,619 | 13; 5,261 | 1; 263 | 16; 4,551 |
| Function- 2 weeks | −0.45 (−0.52, −0.38), I2= 59% | −0.47 (−0.56, −0.37), I2= 69% | −0.44 (−0.50, −0.37), I2= 23% | −0.40 (−0.46, −0.35), I2= 0 | −0.15 (−0.40, 0.09), I2= NA | −0.51 (−0.63, −0.39), I2= 69% |
| N RCTs; N Patients | 35; 11,979 | 26; 8,966 | 22; 8,002 | 20; 6,219 | 1; 263 | 21; 6,282 |
| Function- 4 weeks | −0.38 (−0.43, −0.33), I2= 45% | −0.40 (−0.46, −0.33), I2= 49% | −0.34 (−0.40, −0.28), I2= 31% | −0.32 (−0.37, −0.26), I2= 19% | −0.31 (−0.56, −0.07), I2= NA | −0.43 (−0.52, −0.35), I2= 57% |
| N RCTs; N Patients | 7; 2,492 | 5; 1,630 | 1; 460 | 4; 1,581 | ND | 3; 911 |
| Function- 8 weeks | −0.37 (−0.45, −0.29), I2= 0 | −0.41 (−0.52, −0.30), I2= 0 | −0.33 (−0.52, −0.15), I2= NA | −0.35 (−0.45, −0.25), I2= 0 | NA | −0.40 (−0.61, −0.20), I2= 48% |
| N RCTs; N Patients | 23; 10,118 | 17; 7,320 | 14; 6,784 | 13; 6,395 | 2; 571 | 12; 4,165 |
| Function- 12 weeks | −0.34 (−0.39, −0.29), I2= 28% | −0.35 (−0.42, −0.28), I2= 44% | −0.31 (−0.36, −0.25), I2= 17% | −0.29 (−0.34, −0.24), I2= 0 | −0.26 (−0.43, −0.10), I2= 0 | −0.40 (−0.48, −0.31), I2= 39% |
| N RCTs; N Patients | 2; 976 | 2; 976 | 2; 976 | 2; 976 | ND | ND |
| Function- 26 weeks | −0.19 (−0.32, −0.07), I2= 0 | −0.19 (−0.32, −0.07), I2= 0 | −0.19 (−0.32, −0.07), I2= 0 | −0.19 (−0.32, −0.07), I2= 0 | NA | NA |
”Very Low Quality” was defined as studies that received ≥2 High Risk of Bias ratings OR one specific High Risk Rating in the “Other” category in addition to ≥2 Unclear Risk ratings OR ≥3 Unclear Risk of Bias ratings in dimensions other than the “Other” category.
Paul 2009 was removed due to I2 value of 93% and extremely large effect.
Statistically significant effects are written in bold font. Negative standardized mean differences favor Treatment, and positive standardized mean differences favor Placebo. RCT= Randomized controlled trial; N= “number of…”; CI= Confidence Interval; SMD= Standardized Mean Difference; I2= measure of heterogeneity, with 100% being the maximum possible heterogeneity; ND= No data; NA= Not applicable