J Rheum Dis.  2017 Oct;24(5):293-302. 10.4078/jrd.2017.24.5.293.

Cardiovascular and Gastrointestinal Effects of Etoricoxib in the Treatment of Osteoarthritis: A Systematic Review and Network Meta-analysis

• Kim D
• Cho SK
• Nam SW
• Kwon HH
• Jung SY
• Jeon CH
• Im SG
• Kim D
• Jang EJ
• Sung YK

• KMID: 2394345
• DOI: http://doi.org/10.4078/jrd.2017.24.5.293

Abstract

OBJECTIVE
To estimate the cardiovascular (CV) and gastrointestinal (GI) risks of etoricoxib in the treatment of osteoarthritis (OA) compared to a placebo and other non-steroidal anti-inflammatory drugs (NSAIDs).
METHODS
A systematic review of randomized, controlled trials (RCTs) of etoricoxib were performed. Bayesian network meta-analysis was used over a duration of 12 weeks. The incidence of CV and GI events for a duration ≥26 weeks were also tabulated and presented using descriptive statistics.
RESULTS
From this search, 10 studies were identified. Of these, 6 and 5 RCTs that measured the CV and GI events at 12 weeks were included in meta-analysis. They showed that etoricoxib did not increase the CV events compared to the placebo or NSAIDs during the 12 week period (odds ratio [OR]=0.59 compared to celecoxib, OR=0.89 with ibuprofen, OR=0.70 with placebo, and OR=2.16 with naproxen). The risk of GI events was comparable to that of most comparators, with the exception of naproxen, which had a significantly lower risk of GI events (OR=0.18) during the 12 week period. For a duration ≥26 weeks, the incidence of CV and GI events with etoricoxib increased with increasing duration.
CONCLUSION
Etoricoxib is an alternative short-term treatment option for OA, showing comparable CV and GI complications to other NSAIDs. Nevertheless, further studies will be needed to elucidate the long-term safety of etoricoxib in the treatment of OA.

Keyword

Anti-inflammatory agents; non-steroidal; Etoricoxib; Osteoarthritis; Safety

MeSH Terms

Anti-Inflammatory Agents
Anti-Inflammatory Agents, Non-Steroidal
Celecoxib
Ibuprofen
Incidence
Naproxen
Osteoarthritis*
Anti-Inflammatory Agents
Anti-Inflammatory Agents, Non-Steroidal
Celecoxib
Ibuprofen
Naproxen

Figure

• 

  Figure 1. Study selection flow. RCT: randomized controlled trial.

• 

  Figure 2. Network of comparisons with a 12-week treatment duration included in the meta-analyses. Lines represent comparison between two medication, and numbers on the line stand for the number of studies. (A) Cardiovascular events. (B) Gastrointestinal events.

• 

  Figure 3. Estimates of cardiovascular events of etoricoxib compared with NSAIDs and placebo in osteoarthritis of any site (A), osteoarthritis of lower extremities (B), and subgroup analysis according to dose (C) with a duration of 12 weeks. NSAIDs: non-steroidal anti-inflammatory drugs, CrI: credible interval, P (OR>1): posterior probability that the odds ratio (OR) is higher than 1.

• 

  Figure 4. Estimates of gastrointestinal events of etoricoxib compared with NSAIDs and placebo in osteoarthritis of any site (A), osteoarthritis of lower extremities (B), and subgroup analysis according to dose (C) with a treatment duration of 12 weeks. NSAIDs: non-steroidal anti-inflammatory drugs, CrI: credible interval, P (OR>1): posterior probability that the odds ratio (OR) is higher than 1.

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