Efficacy of Celecoxib and Naproxen for Treating Osteoarthritis or Rheumatoid Arthritis: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

MENG Min ¹ , LIU Lichun ¹ , GE Bin ¹ ,  TANG Hao ¹ , WU Yuqiong ² , XU Yang ³

1. Gansu Province People’s Hospital, Lanzhou 730000, China;2. The Second People’s Hospital of Gansu Province, Lanzhou 73000, China;3. Gansu Province Tumor Hospital, Lanzhou 730000, China;

Corresponding author：

TANG Hao, Email: jjiwwo@yahoo.com.cn

Keywords：

Celecoxib; Naproxen; Rheumatoid arthritis; Osteoarthritis; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20110099

Video：

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Objective 　 To evaluate the efficacy and safety of Celecoxib and Naproxen for treating osteoarthritis or rheumatoid arthritis.
Methods 　Such databases as EMbase, PubMed, The Cochrane Library, Chinese Biomedical Literature Database (CBM), China Journal Full-text Database (CJFD), and Chinese Scientific Journal Full-text Database (CSJD) were searched to collect the randomized controlled trials (RCTs) of Celecoxib and Naproxen for treating osteoarthritis or rheumatoid arthritis. Two reviewers independently assessed the quality of the included studies and extracted the data. The Review Manager (version 5.0) software was used to analyze the data.
Results 　Four RCTs involving 2 931 patients were included. The results of meta-analyses were as follows: a) There were significant differences in the dose of Celecoxib and Naproxen for treating rheumatoid arthritis or osteoarthritis; b) There was no significant difference in gastrointestinal reaction between the Celecoxib group and the placebo group (RR=1.29, 95%CI 0.93 to 1.79); c) The were significant differences in gastrointestinal reaction between the Celecoxib group and the Naproxen group (RR=0.78, 95%CI 0.64 to 0.95); d) There were significant differences in inducing the severity of Stomach and Duodenum Endoscopy Score between the Celecoxib group and the Naproxen group when treating rheumatoid arthritis or osteoarthritis (RR=1.29, 95%CI 0.93 to 1.79). As the Intention-To-Treat (ITT) analysis showed, there were significant differences in inducing the severity of gastrointestinal reaction between the Celecoxib group and the Naproxen group when treating rheumatoid arthritis or osteoarthritis (RR=0.84, 95%CI 0.77 to 0.92).
Conclusion 　Compared with Naproxen, there are significant differences in efficacy for treating rheumatoid arthritis and osteoarthritis with Celecoxib in different doses. The Celecoxib has no significant difference in gastrointestinal reaction compared with the placebo group. The Celecoxib group has fewer gastrointestinal side-effects as compared with the Naproxen group, so it can be used to treat rheumatoid arthritis and osteoarthritis in clinic. The results still need to be confirmed by high-quality RCTs.

Citation： MENG Min,LIU Lichun,GE Bin,TANG Hao,WU Yuqiong,XU Yang. Efficacy of Celecoxib and Naproxen for Treating Osteoarthritis or Rheumatoid Arthritis: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2011, 11(5): 560-564. doi: 10.7507/1672-2531.20110099 Copy

1.	1 Kvien TK. Epidemiology and burden of illness of rheumatoid arthritis. Pharmacoeconomics , 2004, 22(2 Suppl 1): 1-12.
2.	Nivsrkar M. Improvement in circulating superoxide dismutase levels: Role of nonsteroidal anti-inflammatory drugs in rheumatoid arthritis biochemical and biophysical. Research Communications , 2000, 270(3): 714-716.
3.	毕会民, 胡胜, 甘佩珍, 等. 塞来考昔对女性卵巢功能的影响. 中国新药与临床, 2004, 23(8): 538-539.
4.	Niederberger E, Manderscheid C, Grösch S, et al . Effects of the selective COX-2 inhibitors celecoxib and rofecoxib on human vascular cells. Biochem Pharmacol , 2004, 68(2): 341-350.
5.	Laine L, Connor LG, Reicin A, et al . Serious lower gastrointestinal clinical events with nonselective NSAID or Coxib Use. Gastroenterology , 2003, 124(2): 288-292.
6.	Jadad AR, Moore RA, Carroll D, et al . Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials , 1996, 17(1): 1-12.
7.	Bensen WG, Flechtner JJ, Mcmillen JI, et al . Treatment of osteoarthritis with Celecoxib, a cyclooxygensae-2 Inhibitor: A randomized controlled trial. Mayo Clin Proc , 1999, 74(11): 1095-1105.
8.	Simon LS, Weave AL, Graham DY, et al . Anti-inflammatory and upper gastrointestinal effects of Celecoxib in rheumatoid arthritis: A randomized controlled trial. JAMA , 1999, 282(20): 1921-1928.
9.	Goldstein JL, Correa P, Zhao WW, et al . Reduced incidence of gastroduodenal ulcers with celecoxib, a novel cyclooxygenase-2 inhibitor, compared to naproxen in patients with arthritis. Am J Gastroenterol , 2001, 96(4): 1019-1027.
10.	Foeldvari I, Szer IS, Zemel LS, et al . A prospective study comparing Celecoxib with Naproxen in children with juvenile rheumatoid arthritis. The Journal of Rheumatology , 2009, 36(1): 174-182.
11.	Zhao SZ, Mcmillen JI, Markenson JA, et al . Evaluation of the functional status aspects of Health-Related Quality of Life of patients with osteoarthritis treated with Celecoxib. Pharmacotherapy , 1999, 19(11): 1269-1278.
12.	Zhao SZ, Fiechtner JJ, Tindall EA, et al . Evaluation of Health-Related Quality of Life of rheumatoid arthritis patients treated with Celecoxib. Arthritis Care and Research , 2000, 13(2): 112-121.
13.	Becker MC, Wang TH, Wisniewski L, et al . Rationale, design, and governance of prospective randomized evaluation of Celecoxib integrated safety versus Ibuprofen or Naproxen (PRECISION), a cardiovascular end point trial of nonsteroidal anti-inflammatory agents in patients with arthritis. Am Heart J , 2009, 157(4): 606-612.
14.	Bensen WG, Fiechtner JJ, Mcmillen JI, 等. 塞来昔布治疗骨关节炎的随机对照试验. 中国新药杂志, 2000, 9(8): 569-574.
15.	Solomon SD, Wittes J, Finn PV, et al . Cardiovascular risk of Celecoxib in 6 randomized placebo-controlled trials: the cross trial safety analysis. Circulatio , 2008, 117(16): 2104-2113.
16.	Lelorier J, Fitzsimon C, Keresteci M, et al . Drug utilization review of Celecoxib in Ontario. Rheumatology , 2003, 42(suppl 3): 11-16.
17.	徐慧敏, 徐翔. 综合性医院门诊患者塞来昔布（西乐葆）使用的处方分析. 中国药学杂志, 2009, 44(20): 1596-1598.

1. 1 Kvien TK. Epidemiology and burden of illness of rheumatoid arthritis. Pharmacoeconomics , 2004, 22(2 Suppl 1): 1-12.
2. Nivsrkar M. Improvement in circulating superoxide dismutase levels: Role of nonsteroidal anti-inflammatory drugs in rheumatoid arthritis biochemical and biophysical. Research Communications , 2000, 270(3): 714-716.
3. 毕会民, 胡胜, 甘佩珍, 等. 塞来考昔对女性卵巢功能的影响. 中国新药与临床, 2004, 23(8): 538-539.
4. Niederberger E, Manderscheid C, Grösch S, et al . Effects of the selective COX-2 inhibitors celecoxib and rofecoxib on human vascular cells. Biochem Pharmacol , 2004, 68(2): 341-350.
5. Laine L, Connor LG, Reicin A, et al . Serious lower gastrointestinal clinical events with nonselective NSAID or Coxib Use. Gastroenterology , 2003, 124(2): 288-292.
6. Jadad AR, Moore RA, Carroll D, et al . Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials , 1996, 17(1): 1-12.
7. Bensen WG, Flechtner JJ, Mcmillen JI, et al . Treatment of osteoarthritis with Celecoxib, a cyclooxygensae-2 Inhibitor: A randomized controlled trial. Mayo Clin Proc , 1999, 74(11): 1095-1105.
8. Simon LS, Weave AL, Graham DY, et al . Anti-inflammatory and upper gastrointestinal effects of Celecoxib in rheumatoid arthritis: A randomized controlled trial. JAMA , 1999, 282(20): 1921-1928.
9. Goldstein JL, Correa P, Zhao WW, et al . Reduced incidence of gastroduodenal ulcers with celecoxib, a novel cyclooxygenase-2 inhibitor, compared to naproxen in patients with arthritis. Am J Gastroenterol , 2001, 96(4): 1019-1027.
10. Foeldvari I, Szer IS, Zemel LS, et al . A prospective study comparing Celecoxib with Naproxen in children with juvenile rheumatoid arthritis. The Journal of Rheumatology , 2009, 36(1): 174-182.
11. Zhao SZ, Mcmillen JI, Markenson JA, et al . Evaluation of the functional status aspects of Health-Related Quality of Life of patients with osteoarthritis treated with Celecoxib. Pharmacotherapy , 1999, 19(11): 1269-1278.
12. Zhao SZ, Fiechtner JJ, Tindall EA, et al . Evaluation of Health-Related Quality of Life of rheumatoid arthritis patients treated with Celecoxib. Arthritis Care and Research , 2000, 13(2): 112-121.
13. Becker MC, Wang TH, Wisniewski L, et al . Rationale, design, and governance of prospective randomized evaluation of Celecoxib integrated safety versus Ibuprofen or Naproxen (PRECISION), a cardiovascular end point trial of nonsteroidal anti-inflammatory agents in patients with arthritis. Am Heart J , 2009, 157(4): 606-612.
14. Bensen WG, Fiechtner JJ, Mcmillen JI, 等. 塞来昔布治疗骨关节炎的随机对照试验. 中国新药杂志, 2000, 9(8): 569-574.
15. Solomon SD, Wittes J, Finn PV, et al . Cardiovascular risk of Celecoxib in 6 randomized placebo-controlled trials: the cross trial safety analysis. Circulatio , 2008, 117(16): 2104-2113.
16. Lelorier J, Fitzsimon C, Keresteci M, et al . Drug utilization review of Celecoxib in Ontario. Rheumatology , 2003, 42(suppl 3): 11-16.
17. 徐慧敏, 徐翔. 综合性医院门诊患者塞来昔布（西乐葆）使用的处方分析. 中国药学杂志, 2009, 44(20): 1596-1598.

Chinese Journal of Evidence-Based Medicine

Efficacy of Celecoxib and Naproxen for Treating Osteoarthritis or Rheumatoid Arthritis: A Meta-analysis

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