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RETRACTED: Effectiveness of non-steroidal anti-inflammatory drugs for the treatment of pain in knee and hip osteoarthritis: a network meta-analysis.

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Title: RETRACTED: Effectiveness of non-steroidal anti-inflammatory drugs for the treatment of pain in knee and hip osteoarthritis: a network meta-analysis.
Authors: da Costa, Bruno R., Reichenbach, Stephan, Keller, Noah, Nartey, Linda, Wandel, Simon, Jüni, Peter, Trelle, Sven
Source: Lancet. 5/21/2016, Vol. 387 Issue 10033, p2093-2105. 13p.
Subjects: Nonsteroidal anti-inflammatory agents, Analgesia, Knee injuries, Meta-analysis, Randomized controlled trials, Bayesian analysis, Osteoarthritis treatment, Clinical trials, Comparative studies, Dose-effect relationship in pharmacology, Hip joint diseases, Knee diseases, Research methodology, Medical cooperation, Osteoarthritis, Probability theory, Research, Evaluation research, Treatment effectiveness, Joint pain, Disease complications
Abstract: Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are the backbone of osteoarthritis pain management. We aimed to assess the effectiveness of different preparations and doses of NSAIDs on osteoarthritis pain in a network meta-analysis.Methods: For this network meta-analysis, we considered randomised trials comparing any of the following interventions: NSAIDs, paracetamol, or placebo, for the treatment of osteoarthritis pain. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) and the reference lists of relevant articles for trials published between Jan 1, 1980, and Feb 24, 2015, with at least 100 patients per group. The prespecified primary and secondary outcomes were pain and physical function, and were extracted in duplicate for up to seven timepoints after the start of treatment. We used an extension of multivariable Bayesian random effects models for mixed multiple treatment comparisons with a random effect at the level of trials. For the primary analysis, a random walk of first order was used to account for multiple follow-up outcome data within a trial. Preparations that used different total daily dose were considered separately in the analysis. To assess a potential dose-response relation, we used preparation-specific covariates assuming linearity on log relative dose.Findings: We identified 8973 manuscripts from our search, of which 74 randomised trials with a total of 58,556 patients were included in this analysis. 23 nodes concerning seven different NSAIDs or paracetamol with specific daily dose of administration or placebo were considered. All preparations, irrespective of dose, improved point estimates of pain symptoms when compared with placebo. For six interventions (diclofenac 150 mg/day, etoricoxib 30 mg/day, 60 mg/day, and 90 mg/day, and rofecoxib 25 mg/day and 50 mg/day), the probability that the difference to placebo is at or below a prespecified minimum clinically important effect for pain reduction (effect size [ES] -0·37) was at least 95%. Among maximally approved daily doses, diclofenac 150 mg/day (ES -0·57, 95% credibility interval [CrI] -0·69 to -0·46) and etoricoxib 60 mg/day (ES -0·58, -0·73 to -0·43) had the highest probability to be the best intervention, both with 100% probability to reach the minimum clinically important difference. Treatment effects increased as drug dose increased, but corresponding tests for a linear dose effect were significant only for celecoxib (p=0·030), diclofenac (p=0·031), and naproxen (p=0·026). We found no evidence that treatment effects varied over the duration of treatment. Model fit was good, and between-trial heterogeneity and inconsistency were low in all analyses. All trials were deemed to have a low risk of bias for blinding of patients. Effect estimates did not change in sensitivity analyses with two additional statistical models and accounting for methodological quality criteria in meta-regression analysis.Interpretation: On the basis of the available data, we see no role for single-agent paracetamol for the treatment of patients with osteoarthritis irrespective of dose. We provide sound evidence that diclofenac 150 mg/day is the most effective NSAID available at present, in terms of improving both pain and function. Nevertheless, in view of the safety profile of these drugs, physicians need to consider our results together with all known safety information when selecting the preparation and dose for individual patients.Funding: Swiss National Science Foundation (grant number 405340-104762) and Arco Foundation, Switzerland. [ABSTRACT FROM AUTHOR]
Copyright of Lancet is the property of Lancet and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: RETRACTED: Effectiveness of non-steroidal anti-inflammatory drugs for the treatment of pain in knee and hip osteoarthritis: a network meta-analysis.
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  Data: <searchLink fieldCode="AR" term="%22da+Costa%2C+Bruno+R%2E%22">da Costa, Bruno R.</searchLink><br /><searchLink fieldCode="AR" term="%22Reichenbach%2C+Stephan%22">Reichenbach, Stephan</searchLink><br /><searchLink fieldCode="AR" term="%22Keller%2C+Noah%22">Keller, Noah</searchLink><br /><searchLink fieldCode="AR" term="%22Nartey%2C+Linda%22">Nartey, Linda</searchLink><br /><searchLink fieldCode="AR" term="%22Wandel%2C+Simon%22">Wandel, Simon</searchLink><br /><searchLink fieldCode="AR" term="%22Jüni%2C+Peter%22">Jüni, Peter</searchLink><br /><searchLink fieldCode="AR" term="%22Trelle%2C+Sven%22">Trelle, Sven</searchLink>
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  Data: <searchLink fieldCode="JN" term="%22Lancet%22">Lancet</searchLink>. 5/21/2016, Vol. 387 Issue 10033, p2093-2105. 13p.
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  Data: <searchLink fieldCode="DE" term="%22Nonsteroidal+anti-inflammatory+agents%22">Nonsteroidal anti-inflammatory agents</searchLink><br /><searchLink fieldCode="DE" term="%22Analgesia%22">Analgesia</searchLink><br /><searchLink fieldCode="DE" term="%22Knee+injuries%22">Knee injuries</searchLink><br /><searchLink fieldCode="DE" term="%22Meta-analysis%22">Meta-analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Randomized+controlled+trials%22">Randomized controlled trials</searchLink><br /><searchLink fieldCode="DE" term="%22Bayesian+analysis%22">Bayesian analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Osteoarthritis+treatment%22">Osteoarthritis treatment</searchLink><br /><searchLink fieldCode="DE" term="%22Clinical+trials%22">Clinical trials</searchLink><br /><searchLink fieldCode="DE" term="%22Comparative+studies%22">Comparative studies</searchLink><br /><searchLink fieldCode="DE" term="%22Dose-effect+relationship+in+pharmacology%22">Dose-effect relationship in pharmacology</searchLink><br /><searchLink fieldCode="DE" term="%22Hip+joint+diseases%22">Hip joint diseases</searchLink><br /><searchLink fieldCode="DE" term="%22Knee+diseases%22">Knee diseases</searchLink><br /><searchLink fieldCode="DE" term="%22Research+methodology%22">Research methodology</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+cooperation%22">Medical cooperation</searchLink><br /><searchLink fieldCode="DE" term="%22Osteoarthritis%22">Osteoarthritis</searchLink><br /><searchLink fieldCode="DE" term="%22Probability+theory%22">Probability theory</searchLink><br /><searchLink fieldCode="DE" term="%22Research%22">Research</searchLink><br /><searchLink fieldCode="DE" term="%22Evaluation+research%22">Evaluation research</searchLink><br /><searchLink fieldCode="DE" term="%22Treatment+effectiveness%22">Treatment effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Joint+pain%22">Joint pain</searchLink><br /><searchLink fieldCode="DE" term="%22Disease+complications%22">Disease complications</searchLink>
– Name: Abstract
  Label: Abstract
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  Data: <bold>Background: </bold>Non-steroidal anti-inflammatory drugs (NSAIDs) are the backbone of osteoarthritis pain management. We aimed to assess the effectiveness of different preparations and doses of NSAIDs on osteoarthritis pain in a network meta-analysis.<bold>Methods: </bold>For this network meta-analysis, we considered randomised trials comparing any of the following interventions: NSAIDs, paracetamol, or placebo, for the treatment of osteoarthritis pain. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) and the reference lists of relevant articles for trials published between Jan 1, 1980, and Feb 24, 2015, with at least 100 patients per group. The prespecified primary and secondary outcomes were pain and physical function, and were extracted in duplicate for up to seven timepoints after the start of treatment. We used an extension of multivariable Bayesian random effects models for mixed multiple treatment comparisons with a random effect at the level of trials. For the primary analysis, a random walk of first order was used to account for multiple follow-up outcome data within a trial. Preparations that used different total daily dose were considered separately in the analysis. To assess a potential dose-response relation, we used preparation-specific covariates assuming linearity on log relative dose.<bold>Findings: </bold>We identified 8973 manuscripts from our search, of which 74 randomised trials with a total of 58,556 patients were included in this analysis. 23 nodes concerning seven different NSAIDs or paracetamol with specific daily dose of administration or placebo were considered. All preparations, irrespective of dose, improved point estimates of pain symptoms when compared with placebo. For six interventions (diclofenac 150 mg/day, etoricoxib 30 mg/day, 60 mg/day, and 90 mg/day, and rofecoxib 25 mg/day and 50 mg/day), the probability that the difference to placebo is at or below a prespecified minimum clinically important effect for pain reduction (effect size [ES] -0·37) was at least 95%. Among maximally approved daily doses, diclofenac 150 mg/day (ES -0·57, 95% credibility interval [CrI] -0·69 to -0·46) and etoricoxib 60 mg/day (ES -0·58, -0·73 to -0·43) had the highest probability to be the best intervention, both with 100% probability to reach the minimum clinically important difference. Treatment effects increased as drug dose increased, but corresponding tests for a linear dose effect were significant only for celecoxib (p=0·030), diclofenac (p=0·031), and naproxen (p=0·026). We found no evidence that treatment effects varied over the duration of treatment. Model fit was good, and between-trial heterogeneity and inconsistency were low in all analyses. All trials were deemed to have a low risk of bias for blinding of patients. Effect estimates did not change in sensitivity analyses with two additional statistical models and accounting for methodological quality criteria in meta-regression analysis.<bold>Interpretation: </bold>On the basis of the available data, we see no role for single-agent paracetamol for the treatment of patients with osteoarthritis irrespective of dose. We provide sound evidence that diclofenac 150 mg/day is the most effective NSAID available at present, in terms of improving both pain and function. Nevertheless, in view of the safety profile of these drugs, physicians need to consider our results together with all known safety information when selecting the preparation and dose for individual patients.<bold>Funding: </bold>Swiss National Science Foundation (grant number 405340-104762) and Arco Foundation, Switzerland. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
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  Data: <i>Copyright of Lancet is the property of Lancet and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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RecordInfo BibRecord:
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      – Type: doi
        Value: 10.1016/S0140-6736(16)30002-2
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      – Code: eng
        Text: English
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      Pagination:
        PageCount: 13
        StartPage: 2093
    Subjects:
      – SubjectFull: Nonsteroidal anti-inflammatory agents
        Type: general
      – SubjectFull: Analgesia
        Type: general
      – SubjectFull: Knee injuries
        Type: general
      – SubjectFull: Meta-analysis
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      – SubjectFull: Randomized controlled trials
        Type: general
      – SubjectFull: Bayesian analysis
        Type: general
      – SubjectFull: Osteoarthritis treatment
        Type: general
      – SubjectFull: Clinical trials
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      – SubjectFull: Comparative studies
        Type: general
      – SubjectFull: Dose-effect relationship in pharmacology
        Type: general
      – SubjectFull: Hip joint diseases
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      – SubjectFull: Knee diseases
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      – SubjectFull: Research methodology
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      – SubjectFull: Medical cooperation
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      – SubjectFull: Osteoarthritis
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      – SubjectFull: Probability theory
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      – SubjectFull: Research
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      – SubjectFull: Evaluation research
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      – SubjectFull: Treatment effectiveness
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      – SubjectFull: Joint pain
        Type: general
      – SubjectFull: Disease complications
        Type: general
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      – TitleFull: RETRACTED: Effectiveness of non-steroidal anti-inflammatory drugs for the treatment of pain in knee and hip osteoarthritis: a network meta-analysis.
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              Text: 5/21/2016
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