PMID- 12240779
OWN - NLM
STAT- MEDLINE
DCOM- 20030312
LR  - 20190922
IS  - 0149-2918 (Print)
IS  - 0149-2918 (Linking)
VI  - 24
IP  - 8
DP  - 2002 Aug
TI  - Dose-effect relationships of nonsteroidal anti-inflammatory drugs: a literature 
      review.
PG  - 1225-91
AB  - BACKGROUND: Many clinicians believe that higher doses of nonsteroidal 
      anti-inflammatory drugs (NSAIDs) are more effective than lower doses for the 
      treatment of rheumatoid arthritis (RA) and osteoarthritis (OA) but are associated 
      with higher rates of adverse events (AEs). However, there is a lack of consensus 
      on dose-effect relationships with the NSAIDs. OBJECTIVE: The purpose of this 
      review was to investigate evidence for the relationship between NSAID dose, 
      efficacy, and the occurrence of AEs from clinical trials of RA and OA of the hip 
      and knee. METHODS: Relevant English-language publications were identified through 
      a search of EMBASE, MEDLINE, and REFLINE using the terms aceclofenac, diclofenac, 
      etodolac, ibuprofen, isoxicam, lornoxicam, meloxicam, nabumetone, naproxen, 
      piroxicam, tenidap, tenoxicam, arthritis, OA (hip and knee), RA, rheumatic 
      disorders, and musculoskeletal disorders for the period January 1970 to December 
      1997 (this review was conducted in 1998). Bibliographies of retrieved 
      publications were reviewed for other potentially relevant articles. Selected 
      publications were evaluated for quality (likelihood of bias) based on 4 factors 
      (randomization procedure; completeness of patient and treatment information; 
      standardization and completeness of outcome data; and reporting of attrition 
      data). RESULTS: This review included 99 publications concerning clinical trials 
      conducted in 24 countries and enrolling 28,239 patients. The majority of reports 
      were published in the 1990s, particularly in the latter half of that decade. The 
      average quality of the publications improved over time, with a significant 
      increase in mean quality score from 5.43 in the 1970s to 9.21 during the last 
      half of the 1990s (P < 0.05). Only 8 reports directly compared high and low doses 
      of the same drug in relation to efficacy. CONCLUSIONS: Data on the relationship 
      of NSAID dose to efficacy and the incidence of AEs were limited. There is a need 
      for clinical trials directly addressing dose-effect relationships of NSAIDs, as 
      well as reviews of more current literature and reports in languages other than 
      English.
FAU - Emery, Paul
AU  - Emery P
AD  - Rheumatology and Rehabilitation Research Unit, Research School of Medicine, 
      University of Leeds, United Kingdom.
FAU - Kong, Sheldon X
AU  - Kong SX
FAU - Ehrich, Elliot W
AU  - Ehrich EW
FAU - Watson, Douglas J
AU  - Watson DJ
FAU - Towheed, Tanveer E
AU  - Towheed TE
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PL  - United States
TA  - Clin Ther
JT  - Clinical therapeutics
JID - 7706726
RN  - 0 (Anti-Inflammatory Agents, Non-Steroidal)
SB  - IM
MH  - *Anti-Inflammatory Agents, Non-Steroidal/administration & dosage/adverse 
      effects/therapeutic use
MH  - Arthritis, Rheumatoid/*drug therapy
MH  - Dose-Response Relationship, Drug
MH  - Osteoarthritis/*drug therapy
MH  - Randomized Controlled Trials as Topic
RF  - 99
EDAT- 2002/09/21 10:00
MHDA- 2003/03/13 04:00
CRDT- 2002/09/21 10:00
PHST- 2002/09/21 10:00 [pubmed]
PHST- 2003/03/13 04:00 [medline]
PHST- 2002/09/21 10:00 [entrez]
AID - S0149-2918(02)80033-9 [pii]
AID - 10.1016/s0149-2918(02)80033-9 [doi]
PST - ppublish
SO  - Clin Ther. 2002 Aug;24(8):1225-91. doi: 10.1016/s0149-2918(02)80033-9.