PMID- 34174454
OWN - NLM
STAT- MEDLINE
DCOM- 20220222
LR  - 20220222
IS  - 1522-9653 (Electronic)
IS  - 1063-4584 (Linking)
VI  - 29
IP  - 9
DP  - 2021 Sep
TI  - Comparative efficacy and safety of acetaminophen, topical and oral non-steroidal 
      anti-inflammatory drugs for knee osteoarthritis: evidence from a network 
      meta-analysis of randomized controlled trials and real-world data.
PG  - 1242-1251
LID - S1063-4584(21)00810-4 [pii]
LID - 10.1016/j.joca.2021.06.004 [doi]
AB  - OBJECTIVE: Current global guidelines regarding the first-line analgesics 
      (acetaminophen, topical or oral non-steroidal anti-inflammatory drugs [NSAIDs]) 
      for knee osteoarthritis remain controversial and their comparative risk-benefit 
      profiles have yet to be adequately assessed. DESIGN: Pubmed, Embase, Cochrane 
      Library, and Web of Science were searched from database inception to March 2021 
      for randomized controlled trials (RCTs) comparing acetaminophen, topical NSAIDs 
      and oral NSAIDs directly or indirectly in knee osteoarthritis. Bayesian network 
      meta-analyses were conducted. A propensity-score matched cohort study was also 
      conducted among patients with knee osteoarthritis in The Health Improvement 
      Network database. RESULTS: 122 RCTs (47,113 participants) were networked. Topical 
      NSAIDs were superior to acetaminophen (standardized mean difference 
      [SMD] = -0.29, 95% credible interval [CrI]: -0.52 to -0.06) and not statistically 
      different from oral NSAIDs (SMD = 0.03, 95% CrI: -0.16 to 0.22) for function. It 
      had lower risk of gastrointestinal adverse effects (AEs) than acetaminophen (risk 
      ratio [RR] = 0.52, 95%CrI: 0.35 to 0.76) and oral NSAIDs (RR = 0.46, 95%CrI: 0.34 
      to 0.61) in RCTs. In real-world data, topical NSAIDs showed lower risks of 
      all-cause mortality (hazard ratio [HR] = 0.59, 95% confidence interval [CI]: 0.52 
      to 0.68), cardiovascular diseases (HR = 0.73, 95%CI: 0.63 to 0.85) and 
      gastrointestinal bleeding (HR = 0.53, 95%CI: 0.41 to 0.69) than acetaminophen 
      during the one-year follow-up (n = 22,158 participants/group). A better safety 
      profile was also observed for topical than oral NSAIDs (n = 14,218 
      participants/group). CONCLUSIONS: Topical NSAIDs are more effective than 
      acetaminophen but not oral NSAIDs for function improvement in people with knee 
      osteoarthritis. Topical NSAIDs are safer than acetaminophen or oral NSAIDs in 
      trials and real-world data.
CI  - Copyright (c) 2021 Osteoarthritis Research Society International. Published by 
      Elsevier Ltd. All rights reserved.
FAU - Zeng, C
AU  - Zeng C
AD  - Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 
      China; Division of Rheumatology, Allergy, and Immunology, Department of Medicine, 
      Massachusetts General Hospital, Harvard Medical School, Boston, USA; The Mongan 
      Institute, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
FAU - Doherty, M
AU  - Doherty M
AD  - Academic Rheumatology, Clinical Sciences Building, University of Nottingham, City 
      Hospital, Nottingham, UK; Arthritis Research UK Pain Centre, Nottingham, UK.
FAU - Persson, M S M
AU  - Persson MSM
AD  - Academic Rheumatology, Clinical Sciences Building, University of Nottingham, City 
      Hospital, Nottingham, UK; Arthritis Research UK Pain Centre, Nottingham, UK.
FAU - Yang, Z
AU  - Yang Z
AD  - Department of Epidemiology and Health Statistics, Xiangya School of Public 
      Health, Central South University, Changsha, China.
FAU - Sarmanova, A
AU  - Sarmanova A
AD  - Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, 
      Bristol, UK.
FAU - Zhang, Y
AU  - Zhang Y
AD  - Division of Rheumatology, Allergy, and Immunology, Department of Medicine, 
      Massachusetts General Hospital, Harvard Medical School, Boston, USA; The Mongan 
      Institute, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
FAU - Wei, J
AU  - Wei J
AD  - Division of Rheumatology, Allergy, and Immunology, Department of Medicine, 
      Massachusetts General Hospital, Harvard Medical School, Boston, USA; The Mongan 
      Institute, Massachusetts General Hospital, Harvard Medical School, Boston, USA; 
      Health Management Center, Xiangya Hospital, Central South University, Changsha, 
      China.
FAU - Kaur, J
AU  - Kaur J
AD  - Academic Rheumatology, Clinical Sciences Building, University of Nottingham, City 
      Hospital, Nottingham, UK; Arthritis Research UK Pain Centre, Nottingham, UK.
FAU - Li, X
AU  - Li X
AD  - Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China.
FAU - Lei, G
AU  - Lei G
AD  - Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 
      China; Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China; 
      Hunan Engineering Research Center of Osteoarthritis, Changsha, China; National 
      Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South 
      University, Changsha, China. Electronic address: lei_guanghua@csu.edu.cn.
FAU - Zhang, W
AU  - Zhang W
AD  - Academic Rheumatology, Clinical Sciences Building, University of Nottingham, City 
      Hospital, Nottingham, UK; Arthritis Research UK Pain Centre, Nottingham, UK. 
      Electronic address: weiya.zhang@nottingham.ac.uk.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Systematic Review
DEP - 20210624
PL  - England
TA  - Osteoarthritis Cartilage
JT  - Osteoarthritis and cartilage
JID - 9305697
RN  - 0 (Anti-Inflammatory Agents, Non-Steroidal)
RN  - 362O9ITL9D (Acetaminophen)
SB  - IM
CIN - Osteoarthritis Cartilage. 2021 Nov;29(11):1624-1625. PMID: 34506943
MH  - Acetaminophen/*administration & dosage
MH  - Administration, Oral
MH  - Administration, Topical
MH  - Anti-Inflammatory Agents, Non-Steroidal/*administration & dosage
MH  - Humans
MH  - Network Meta-Analysis
MH  - Osteoarthritis, Knee/*drug therapy
MH  - Randomized Controlled Trials as Topic
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Acetaminophen
OT  - Cohort
OT  - Meta-analysis
OT  - NSAIDs
OT  - Oral
OT  - Osteoarthritis
OT  - Topical
EDAT- 2021/06/27 06:00
MHDA- 2022/02/23 06:00
CRDT- 2021/06/26 20:13
PHST- 2020/09/24 00:00 [received]
PHST- 2021/05/08 00:00 [revised]
PHST- 2021/06/13 00:00 [accepted]
PHST- 2021/06/27 06:00 [pubmed]
PHST- 2022/02/23 06:00 [medline]
PHST- 2021/06/26 20:13 [entrez]
AID - S1063-4584(21)00810-4 [pii]
AID - 10.1016/j.joca.2021.06.004 [doi]
PST - ppublish
SO  - Osteoarthritis Cartilage. 2021 Sep;29(9):1242-1251. doi: 
      10.1016/j.joca.2021.06.004. Epub 2021 Jun 24.