A comparison of the efficacy and safety of nonsteroidal antiinflammatory agents versus acetaminophen in the treatment of osteoarthritis: A meta-analysis

Authors

  • Chin Lee,

    Corresponding author
    1. Northwestern University, The Feinberg School of Medicine, Chicago, Illinois
    • Northwestern University, The Feinberg School of Medicine, Division of Rheumatology, McGaw Pavilion, 240 East Huron St., 2300, Chicago, IL 60611
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  • Walter L. Straus,

    1. Health Dialog Data Services; West Point, Pennsylvania
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    • Dr. Schnitzer is a consultant for AstraZeneca Pharmaceuticals (London, UK), Glaxo SmithKline (London, UK), Mc-Neil Consumer (Raritan, NJ), Merck & Co., Inc. (West Point, PA), and Norvartis (East Hanover, NJ); he has received clinical research support from AstraZenecea, Merck & Co., Inc., and Novartis; and is on the Speakers' Bureau for Merck & Co., Inc. and Ortho-McNeil Pharmaceutical (Raritan, NJ). Drs. Straus and Barlas are currently employed by Merck & Co., Inc. (West Point, PA). Ms. Vogel was formerly employed by Merck & Co., Inc. (West Point, PA).

  • Robert Balshaw,

    1. Simon Fraser University, Burnaby, British Columbia, Canada
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  • Suna Barlas,

    1. Health Dialog Data Services; West Point, Pennsylvania
    Search for more papers by this author
    • Dr. Schnitzer is a consultant for AstraZeneca Pharmaceuticals (London, UK), Glaxo SmithKline (London, UK), Mc-Neil Consumer (Raritan, NJ), Merck & Co., Inc. (West Point, PA), and Norvartis (East Hanover, NJ); he has received clinical research support from AstraZenecea, Merck & Co., Inc., and Novartis; and is on the Speakers' Bureau for Merck & Co., Inc. and Ortho-McNeil Pharmaceutical (Raritan, NJ). Drs. Straus and Barlas are currently employed by Merck & Co., Inc. (West Point, PA). Ms. Vogel was formerly employed by Merck & Co., Inc. (West Point, PA).

  • Suzanne Vogel,

    1. Health Dialog Data Services; West Point, Pennsylvania
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    • Dr. Schnitzer is a consultant for AstraZeneca Pharmaceuticals (London, UK), Glaxo SmithKline (London, UK), Mc-Neil Consumer (Raritan, NJ), Merck & Co., Inc. (West Point, PA), and Norvartis (East Hanover, NJ); he has received clinical research support from AstraZenecea, Merck & Co., Inc., and Novartis; and is on the Speakers' Bureau for Merck & Co., Inc. and Ortho-McNeil Pharmaceutical (Raritan, NJ). Drs. Straus and Barlas are currently employed by Merck & Co., Inc. (West Point, PA). Ms. Vogel was formerly employed by Merck & Co., Inc. (West Point, PA).

  • Thomas J. Schnitzer

    1. Northwestern University, The Feinberg School of Medicine, Chicago, Illinois
    Search for more papers by this author
    • Dr. Schnitzer is a consultant for AstraZeneca Pharmaceuticals (London, UK), Glaxo SmithKline (London, UK), Mc-Neil Consumer (Raritan, NJ), Merck & Co., Inc. (West Point, PA), and Norvartis (East Hanover, NJ); he has received clinical research support from AstraZenecea, Merck & Co., Inc., and Novartis; and is on the Speakers' Bureau for Merck & Co., Inc. and Ortho-McNeil Pharmaceutical (Raritan, NJ). Drs. Straus and Barlas are currently employed by Merck & Co., Inc. (West Point, PA). Ms. Vogel was formerly employed by Merck & Co., Inc. (West Point, PA).


Abstract

Objective

To perform a meta-analysis comparing the efficacy and safety of recommended dosages of nonsteroidal antiinflammatory drugs (NSAIDs), including cyclooxygenase 2 inhibitors, versus acetaminophen in the treatment of symptomatic hip and knee osteoarthritis.

Methods

Medline and EMBASE searches were performed for original clinical trials directly comparing NSAIDs with acetaminophen. A standardized form was used to abstract all data, including outcome measures of pain at rest, walking pain, and dropouts due to adverse effects. Inverse-variance-weighted mean differences (WMDs) and 95% confidence intervals (95% CI) for pain measures were determined for treatment groups. Odds ratios (ORs) and 95% CIs were calculated for withdrawals due to adverse events. Results were compared using a random effects model.

Results

Seven articles met inclusion criteria with sufficient data for analysis. Participants had a mean age of 61.1 years and 71.1% were women. Test of heterogeneity was not significant for either rest (P = 0.73) or walking (P = 0.76) pain. The scores for overall pain at rest (WMD −6.33 mm on a 100-mm visual analog scale [VAS], 95% CI −9.24, −3.41) and walking pain (WMD –5.76 mm on a 100-mm VAS, 95% CI –8.99, –2.52) favored the NSAID-treated group. Although NSAIDs elevated the risk of withdrawals due to adverse events, the difference was not statistically significant (OR 1.45, 95% CI 0.93, 2.27).

Conclusion

NSAIDs are statistically superior in reducing rest and walking pain compared with acetaminophen for symptomatic osteoarthritis. Safety, measured by discontinuation due to adverse events, was not statistically different between NSAID- and acetaminophen-treated groups.

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