The Meta-Analysis Of Etoricoxib's Efficacy And Safety For Acute Gouty Arthritis

Objective: Non-steroidal Anti-inflammatory Drugs(NSAIDs)have been applied for a century,a data proves that NSAIDs take second place on sales in China,which just inferior to antibiotics.Nonselective NSAIDs are widely used in acute gouty arthritis for the good efficacy,but more adverse reactions were reported.There are more and more randomized controlled trials for efficacy and safety between nonselective NSAIDs and selective COX-2 inhibitors in home and abroad with the latter used in clinical.This paper evaluated the efficacy and safety of etoricoxib for acute gouty arthritis,which was contrasted with indomethacin,diclofenac sodium,celecoxib and meloxicam.Methods: We searched randomized controlled trials of etoricoxib in CNKI,Wanfang,VIP,Cochrane Library,EmBase,OVID and PubMed database.Two researchers selected and read the literatures to evaluate the quality and extract data.A meta-analysis was carried out with RevMan 5.3 provided by the Cochrane Collaboration.Results: A total of 15 literatures were included in the study.Etoricoxib performed better than other NSAIDs in acute gouty arthritis pain relief,which was supported by pain visual analogue scale(VAS),5point Likert scale and the total adverse reaction rate.[SMD=-2.49,95%CI[-3.90,-1.08],P=0.0005;MD=-0.19,95%CI[-0.26,-0.11],P<0.00001;OR=6.24,95%CI[1.75,22.27],P=0.005].Etoricoxib is superior to the other NSAIDs in white blood cell count and C-reactive protein decline.[SMD=-1.41,95%CI[-2.44,-0.39],P=0.007;MD=-0.91,95%[-1.74,-0.08],P=0.03].Etoricoxib has better uric acid lowering effects than nonselective NSAIDs and no significant difference compared with the selective COX-2 inhibitors.[MD=24.64,95%CI[2.69,46.59],P=0.03;MD=-1.37,95%CI[-20.23,17.49],P=0.89].Etoricoxib has less adverse reactions than the nonselective NSAIDs.OR=0.36,95%CI[0.26,0.50],P<0.00001.Compared with other selective COX-2 inhibitors,etoricoxib shows no significant difference.OR=0.65,95%CI[0.40,1.03],P=0.07.Etoricoxib has lower total adverse reaction rate than the other four drugs.OR=0.43,95%CI[0.33,0.56],P<0.00001.Etoricoxib h as fewer gastrointestinal side effects.OR=0.33,95%CI[0.23,0.49],P<0.00001.Etoricoxib shows no significant difference on the cardiovascular side effects with the other NSAIDs.OR=0.77,95%CI[0.44,1.34],P=0.35.Conclusions: Etoricoxib treatment for acute gouty arthritis has good efficacy and high safety,but more randomized controlled trials on its cardiovascular side effects still needed.