PMID- 29436380 OWN - NLM STAT- MEDLINE DCOM- 20180726 LR - 20181202 IS - 1473-0480 (Electronic) IS - 0306-3674 (Print) IS - 0306-3674 (Linking) VI - 52 IP - 10 DP - 2018 May TI - 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. PG - 642-650 LID - 10.1136/bjsports-2017-098043 [doi] AB - 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% CI -0.40 to -0.20) and improving function (SMD=-0.35, 95% CI -0.45 to -0.24) in OA. Of all topical NSAIDs, diclofenac patches were most effective for OA pain (SMD=-0.81, 95% CI -1.12 to -0.52) and piroxicam was most effective for functional improvement (SMD=-1.04, 95% CI -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. CI - (c) 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. FAU - Zeng, Chao AU - Zeng C AD - Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China. AD - Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. FAU - Wei, Jie AU - Wei J AD - Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. AD - Health Management Center, Xiangya Hospital, Central South University, Changsha, China. FAU - Persson, Monica S M AU - Persson MSM AD - Academic Rheumatology, Clinical Sciences Building, University of Nottingham, City Hospital, Nottingham, UK. AD - Arthritis Research UK Pain Centre, Nottingham, UK. FAU - Sarmanova, Aliya AU - Sarmanova A AD - Academic Rheumatology, Clinical Sciences Building, University of Nottingham, City Hospital, Nottingham, UK. AD - Arthritis Research UK Pain Centre, Nottingham, UK. FAU - Doherty, Michael AU - Doherty M AD - Academic Rheumatology, Clinical Sciences Building, University of Nottingham, City Hospital, Nottingham, UK. AD - Arthritis Research UK Pain Centre, Nottingham, UK. FAU - Xie, Dongxing AU - Xie D AD - Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China. FAU - Wang, YiLun AU - Wang Y AD - Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China. FAU - Li, Xiaoxiao AU - Li X AD - Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China. FAU - Li, Jiatian AU - Li J AD - Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China. FAU - Long, Huizhong AU - Long H AD - Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China. FAU - Lei, Guanghua AU - Lei G AD - Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China. AD - Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China. AD - National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China. AD - Center for Clinical Technology and Research of Joint Surgery, Hunan, China. FAU - Zhang, Weiya AU - Zhang W AD - Academic Rheumatology, Clinical Sciences Building, University of Nottingham, City Hospital, Nottingham, UK. AD - Arthritis Research UK Pain Centre, Nottingham, UK. LA - eng PT - Journal Article PT - Meta-Analysis PT - Review PT - Systematic Review DEP - 20180207 PL - England TA - Br J Sports Med JT - British journal of sports medicine JID - 0432520 RN - 0 (Anti-Inflammatory Agents, Non-Steroidal) RN - 0 (Salicylates) SB - IM MH - Administration, Cutaneous MH - Anti-Inflammatory Agents, Non-Steroidal/adverse effects/*therapeutic use MH - Bayes Theorem MH - Humans MH - Network Meta-Analysis MH - Osteoarthritis/*drug therapy MH - Pain/*drug therapy MH - Randomized Controlled Trials as Topic MH - Salicylates/adverse effects/therapeutic use MH - Transdermal Patch PMC - PMC5931249 OTO - NOTNLM OT - meta-analysis OT - osteoarthritis COIS- Competing interests: None declared. EDAT- 2018/02/14 06:00 MHDA- 2018/07/27 06:00 PMCR- 2018/05/02 CRDT- 2018/02/14 06:00 PHST- 2017/12/22 00:00 [accepted] PHST- 2018/02/14 06:00 [pubmed] PHST- 2018/07/27 06:00 [medline] PHST- 2018/02/14 06:00 [entrez] PHST- 2018/05/02 00:00 [pmc-release] AID - bjsports-2017-098043 [pii] AID - 10.1136/bjsports-2017-098043 [doi] PST - ppublish SO - Br J Sports Med. 2018 May;52(10):642-650. doi: 10.1136/bjsports-2017-098043. Epub 2018 Feb 7.