Reachout Orthopedics - Issue 1

Table 1: Description of the studies included in the meta-analysis. Author, year Study design SS Age EG/CG Gender (male/ female) Severity of disease Intervention method EG Intervention method CG Duration treatment Schumacher et al ., 2002 RCT 150 48.5±13.29/49.5±13.71 142/8 A sum score >5 for pain tenderness and swelling Etoricoxib 120 mg administered orally once daily Indomethacin 50 mg administered orally 3 times daily Both for 8 days Rubin et al ., 2007 RCT 189 51.1±13/52.2±12 176/13 A total score >5 for pain tenderness and swelling, with pain score ≥ 2 Etoricoxib 120 mg administered orally once daily Indomethacin 50 mg administered orally 3 times daily Both for 8 days Li et al ., 2013 RCT 178 52±15/53±14 166/12 A sum score >5 for pain tenderness and swelling Etoricoxib 120 mg administered orally once daily Indomethacin 75 mg administered orally 2 times daily Both for 5 days Ye Qiao et al ., 2010 RCT 75 42.12±12.48/38.20±15.51 65/10 Visual analogue scale 6.08±1.85 Etoricoxib 120 mg administered orally once daily Diclofenac 75 mg administered orally once daily Both for 7 days Lu Jian-li, 2014 RCT 146 48.9±2.3/46.7±3.4 138/8 Visual analogue scale 6.31±1.16 Etoricoxib 120 mg administered orally once daily Diclofenac 25 mg administered orally 3 times daily Both for 7 days Guo Min, 2014 RCT 113 40.52±11.27/43.03±13.02 110/3 Mazur 1979 score 2.78±0.83 Etoricoxib 120 mg administered orally once daily Diclofenac 75 mg administered orally once daily Both for 5 days RCT randomized controlled trial, SS sample size, EG experimental group, CG control group Fig. 4: Forest plot of mean difference in efficacy and 95 % CI for 2–5 days follow-up. pain and inflammation in osteoarthritis, ankylosing spondylitis, and rheumatoid arthritis [24–27]. To our knowledge, this is the first quantitative comparative meta-analysis of studies directly comparing etoricoxib and NSAIDs for the treatment of acute gout. Ultimately, six RCTs were included, and a systematic review and meta-analysis were performed to replicate and confirm the results of the studies. In order to assess the efficacy and safety of etoricoxib, we extracted relative data as much as possible, and we pooled the outcome whenever possible. For the efficacy assessment, the overall pooledWMD 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) is for pain relief. It has revealed a different outcome mainly because one article’s [20] mean difference and 95 % CI was −0.64 [−0.51 to −0.41]. In summary, we believe there was no significant difference between etoricoxib and NSAIDs such as indomethacin and diclofenac. 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. The overall outcome showed there was no significant difference among the two interventions after 5 or 7 days of treatment. Therefore, etoricoxib Discussion Acute gouty arthritis is the most common form of inflammatory joint disease. The primary symptom of acute gout is pain. Optimal therapy is directed at controlling inflammation and analgesia [23]. NSAIDs are considered to be the most potent NSAID for the treatment of gout [1]. Etoricoxib, a novel cyclooxygenase 2 (COX-2) inhibitor, has anti-inflammatory, analgesic, and antipyretic activities in models of acute or chronic 11 reachOut Orthopedics