The long‐term effects of non‐steroidal anti‐inflammatory drugs in osteoarthritis of the knee: a randomized placebo‐controlled trial

Abstract

NSAIDs significantly reduce overall pain over 4 weeks. This short-term responsiveness is retained, and even after several years of therapy with tiaprofenic acid pain scores increased over 2 weeks when it was changed to placebo. Our results do not show long-term benefits from the use of NSAIDs in OA and the majority of patients had persisting pain and disability despite therapy.

Non-steroidal anti-inflammatory drugs, including cyclo-oxygenase-2 inhibitors, in osteoarthritic knee pain: meta-analysis of randomised placebo controlled trials

“…Four trials did not present mean change data but only before and after means and P values 30 32 44 45. Eleven trials presented data on overall pain on 100 mm visual analogue scales or on a categorical five point scale,30 – 32 37 38 41 42 47 50 – 52 while the 12 remaining trials presented either categorical or continuous data from the WOMAC subscale for pain. All 23 trials reported data on pain intensity, and 11 trials reported data on functional disability.…”

“…Only four trials presented outcome data as the mean difference of change with SD between NSAIDs and placebo groups 34 42 46 48. Fourteen trials presented the mean difference of change for each group with P values, SE of mean, or 95% confidence intervals but not mean differences between groups 31 33 35 – 39 41 43 47 49 – 52.…”

“…Eleven trials with 7433 patients provided separate scores for reduction in functional disability,33 35 36 39 – 41 43 44 46 – 48 and their combined effect size was 0.29 (95% confidence interval 0.18 to 0.40). One trial reported long term effects on pain but found no significant difference between tiaprofenic acid and placebo at one, two, three, and four years after start of treatment 42. For short term effects (2-13 weeks) the pooled effect size of all included trials was 10.1 mm on visual analogue scale (7.4 to 12.8) or 15.6% better than placebo, and the effect size was 0.32 (0.24 to 0.39) (fig 2).…”

Pain Associated with Osteo‐Arthritis

“…In a long-term randomized trial lasting up to 4 years, 61-63% of patients receiving oral NSAIDs and 50% of those receiving placebo reported adverse events [11]. One systematic review evaluated the ability of COXIBs and other gastroprotective strategies with conventional NSAIDs to reduce upper gastrointestinal risks [12].…”

Pain management in osteoarthritis: A focus on onset of efficacy—a comparison of rofecoxib, celecoxib, acetaminophen, and nabumetone across four clinical trials

“…A previous study that examined patients with mild OA showed the greatest efficacy benefits within 1 month (the first time point assessed) with no further improvement in treatment during a period of 12 months. 34 There is evidence that patients with arthritis allow themselves a "trial period" for treatment determined by their beliefs and expectations. 12 Thus, if efficacy does not meet with expectations, adherence to treatment is negatively affected.…”