Abstract | BACKGROUND: OBJECTIVES: METHODS: The following databases were searched: MEDLINE, EMBASE, Cochrane CENTRAL, CINAHL, AMED, PEDro and SPORTDiscus. Further studies were sought through clinical trials registries, dissertations, correspondence with pharmaceutical companies and manual searches of relevant journals. There was no language restriction. DEFINITIONS: ' Coxibs' were defined as drugs that inhibit COX-2 >5-fold more than COX-1; 'acute' was defined as injury occurring within 48 hours of enrollment; ' soft tissue injury' was defined as closed injuries to upper or lower limb soft tissues (ligaments, muscles or tendons). STUDY SELECTION: DATA EXTRACTION: A standard form was used to extract data. Included studies were screened by the authors for risk of bias using the Cochrane risk of bias tool and evidence was graded for quality using the GRADE tool. DATA SYNTHESIS: Clinical heterogeneity was minimized by application of strict selection criteria. Statistical heterogeneity was assessed using the I2 statistic and meta-analysis was undertaken if appropriate. Weighted mean difference (WMD) was used to assess pain, relative risk (RR) to assess AEs, and Peto odds ratio (OR) to assess return to function. RESULTS: The nine RCTs evaluated in the meta-analysis included 3060 patients. Coxibs were found to be equal to NSAIDs (day 7+, n = 1884, 100 mm visual analogue scale [VAS]), WMD = 0.18 mm (95% CI -1.76, 2.13), p = 0.85 and tramadol (day 7+, n = 706, 100 mm VAS), WMD = -6.6 mm (95% CI -9.63, -3.47) [single study, difference clinically insignificant] for treating pain after soft tissue injuries. Coxibs had fewer gastrointestinal AEs than NSAIDs, even with short-term use (RR 0.59 [95% CI 0.41, 0.85], p = 0.004) [low quality evidence]. Swelling was measured in two studies with no difference being found between groups, but the presentation of the data was not sufficient to allow further analysis. Coxibs were found to be unlikely to be different to NSAIDs in helping patients return to function (OR 1.0 [95% CI 0.77, 1.3], p = 0.99); however, a single study suggested they may improve time to return to function (moderate quality evidence) and may have fewer AEs than tramadol (very low quality evidence). The risk of serious AEs with both coxibs and NSAIDs in this setting was low (but incompletely defined). CONCLUSIONS: More studies comparing coxibs with NSAIDs and other analgesics in the setting of acute soft tissue injuries are necessary. A different review methodology would be required to answer the question of cardiovascular risk associated with short-term use of coxibs and NSAIDs.
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Authors | Peter Jones, Rain Lamdin |
Journal | Clinical drug investigation
(Clin Drug Investig)
Vol. 30
Issue 7
Pg. 419-37
( 2010)
ISSN: 1173-2563 [Print] New Zealand |
PMID | 20527999
(Publication Type: Comparative Study, Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review, Systematic Review)
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Chemical References |
- Analgesics
- Anti-Inflammatory Agents, Non-Steroidal
- Cyclooxygenase 2 Inhibitors
- Cyclooxygenase 2
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Topics |
- Acute Disease
- Administration, Oral
- Analgesics
(adverse effects, pharmacology, therapeutic use)
- Anti-Inflammatory Agents, Non-Steroidal
(adverse effects, pharmacology, therapeutic use)
- Cyclooxygenase 2
(drug effects, metabolism)
- Cyclooxygenase 2 Inhibitors
(adverse effects, pharmacology, therapeutic use)
- Humans
- Pain Measurement
- Randomized Controlled Trials as Topic
- Soft Tissue Injuries
(drug therapy, physiopathology)
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