Relative efficacy and safety of topical non-steroidal anti-inflammatory drugs for osteoarthritis: a systematic review and network meta-analysis of randomised controlled trials and observational studies

Zeng, Chao; Wei, Jie; Persson, Monica S.M.; Sarmanova, Aliya; Doherty, Michael; Xie, Dongxing; Wang, YiLun; Li, Xiaoxiao; Li, Jiatian; Long, Huizhong; Lei, Guanghua; Zhang, Weiya

Abstract

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. Objectives To compare the efficacy and safety of topical non-steroidal anti-inflammatory drugs (NSAIDs), including salicylate, for the treatment of osteoarthritis (OA). Methods PubMed, Embase, Cochrane Library and Web of Science were searched from 1966 to January 2017. Randomised controlled trials (RCTs) comparing topical NSAIDs with placebo or each other in patients with OA and observational studies comparing topical NSAIDs with no treatment or each other irrespective of disease were included. Two investigators identified studies and independently extracted data. Bayesian network and conventional meta-analyses were conducted. The primary outcomes were pain relief for RCTs and risk of adverse effects (AEs) for observational studies. Results 43 studies, comprising 36 RCTs (7 900 patients with OA) and seven observational studies (218 074 participants), were included. Overall, topical NSAIDs were superior to placebo for relieving pain (standardised mean difference (SMD)= '0.30, 95% CÎ'0.40 to -0.20) and improving function (SMD= '0.35, 95% CÎ'0.45 to -0.24) in OA. Of all topical NSAIDs, diclofenac patches were most effective for OA pain (SMD= '0.81, 95% CÎ'1.12 to -0.52) and piroxicam was most effective for functional improvement (SMD= '1.04, 95% CÎ'1.60 to -0.48) compared with placebo. Although salicylate gel was associated with higher withdrawal rates due to AEs, the remaining topical NSAIDs were not associated with any increased local or systemic AEs. Conclusions Topical NSAIDs were effective and safe for OA. Diclofenac patches may be the most effective topical NSAID for pain relief. No serious gastrointestinal and renal AEs were observed in trials or the general population. However, confirmation of the cardiovascular safety of topical NSAIDs still warrants further observational study.

Citation

Zeng, C., Wei, J., Persson, M. S., Sarmanova, A., Doherty, M., Xie, D., Wang, Y., Li, X., Li, J., Long, H., Lei, G., & Zhang, W. (2018). Relative efficacy and safety of topical non-steroidal anti-inflammatory drugs for osteoarthritis: a systematic review and network meta-analysis of randomised controlled trials and observational studies. British Journal of Sports Medicine, 52(10), 642-650. https://doi.org/10.1136/bjsports-2017-098043

• Journal Article Type: Article
• Acceptance Date: Dec 22, 2017
• Online Publication Date: Feb 7, 2018
• Publication Date: 2018-05
• Deposit Date: Nov 26, 2019
• Publicly Available Date: Jan 15, 2020
• Journal: British Journal of Sports Medicine
• Print ISSN: 0306-3674
• Electronic ISSN: 1473-0480
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 52
• Issue: 10
• Pages: 642-650
• DOI: https://doi.org/10.1136/bjsports-2017-098043
• Keywords: Physical Therapy, Sports Therapy and Rehabilitation; Orthopedics and Sports Medicine; General Medicine
• Public URL: https://nottingham-repository.worktribe.com/output/3085882