Reachout Orthopedics - Issue 1

Efficacy of the Etoricoxib We assessed the efficacy of etoricoxib in the treatment of acute gout by the patient’s assessment of pain, investigator’s assessed tenderness of study joints and swelling, patient’s global assessments of response to treatment, and investigators global assessments of response to treatment. Because of high heterogeneity, for assessment of pain, the data cannot be analyzed together. Three studies [9, 18, 19] measured the pain intensity with a 0–4-point scale for 5 days, and two studies [20, 21] measured the pain relief by a visual analogue scale for 7 days, with the overall pooled WMD of −0.10 (95% CI: −0.25 to 0.06, p =0.22) and −0.46 (95% CI: −0.51 to −0.41, p <0.00001) as summarized in Fig. 3. It has revealed a different outcome. For the remaining four outcomes, only three articles [9, 18, 19] have available data; we made a meta-analysis, and there were overall pooled WMDs of −0.14 (95% CI: −0.31 to 0.03, p =0.11), −0.16 (95% CI: −0.33 to 0.02, p =0.08), −0.10 (95% CI: −0.28 to 0.07, p =0.26), and −0.29 (95% CI: −0.46 to −0.11, p =0.26), respectively. There was no significant difference between the two interventions, as shown in Fig. 4. Safety of Etoricoxib Safety assessment for the interventions was calculated by pooling relative data. Adverse events (AEs) were reported in each trial, including any AE, drug-related AEs, and serious AEs. For any AE, the pooled RR value was 0.77 (95% CI: 0.64 to 0.93, p =0.006). For drug-related AEs, the pooled RR was 0.64 (95% CI: 0.50 to 0.81, p =0.0003). There was a significant difference between the two interventions for drug-related AEs. The etoricoxib group had fewer AEs than the NSAID group. For serious AEs, the pooled RR was 0.42 (95% CI: 0.09 to 1.93, p =0.27) (Fig. 5). Drug-related AEs included abdominal distention, diarrhea, stomachache, dizziness, chills, fever, edema of the legs or feet, erythema, or cardiovascular symptoms. The most disparate among the groups were dizziness and gastrointestinal side effects. The pooled RR for the gastrointestinal AE was 0.42 (95% CI: 0.27 to 0.66, p =0.0002), which was significantly different between the two interventions. Patients tolerated the etoricoxib better than those in the NSAID group as shown in Fig. 6. For dizziness, because of the deficient data, we only pooled two trials [19, 9] and found a pooled RR value of 0.37 (95% CI: 0.16 to 0.85, p =0.02). Dizziness was significantly more common in the indomethacin group than in the etoricoxib group as shown in Fig. 6. Fig. 1: Flow chart summarizing trial selection process. Fig. 2: Risk of bias assessment of included studies. Fig. 3: Forest plot of mean difference in patient-assessed pain in the study joint and 95 % CI for 2–5 days follow-up. References obtained through literature search (n=165) PubMed (n = 13) Embase (n = 86) Web of science (n = 44) Cochrane library (n = 5) China Biology medicine (n = 16) A manual search (n = 1) 41 of duplicates have been removed 124 of records screened 25 of full-text articles assessed for eligibility Articles included in final analysis (n = 6) 99 of records excluded, articles excluded with reasons of 73 reviews, 11 conference papers, 4 short surveys, 4 case reports, 4 notes and 3 editorials. 19 of full-text articles have been excluded as they were not pertaining to etoricoxib and NSAIDs. GUO Min 2014 Random sequence generation (selection bias) Allocation concealment (selection bias) Blinding of participants and personnel (performance bias) Blinding of outcome assessment (detection bias) Incomplete outcome data (attrition bias) Selective reporting (reporting bias) Other bias Li 2013 LU Jian-li 2014 Rubin 2004 Schumacher 2002 YE Qiao 2010 10 reachOut Orthopedics