NSAIDs in the Management of Musculoskeletal Conditions: A Comparative Meta-Analysis of the Efficacy/Safety Profile of Piroxicam

PURPOSE
The relative efficacy/safety profiles of various NSAIDs, particularly Piroxicam (PIR), have been repeatedly challenged. Meta-analyses (MA) of case-control studies show more deleterious GI and skin profiles of certain NSAIDs while no such comparison is available from MA of randomized controlled trials, although recent findings show that study design impacts outcomes. We realized this MA to bridge the gap in the understanding of the relative efficacy/safety profile of PIR.
METHODS
We performed a comprehensive systematic research of any comparative randomised controlled trial, peer review, data extraction, quality scoring, and outcome- and comparator- specific meta-analyses. Inclusion criteria were: randomized clinical trial, musculoskeletal condition, active comparator, oral administration, duration over 7 days, 1980-2006. Conservative analyses were stratified by outcome, indication, duration, and doses. Publication bias and robustness were exhaustively investigated.
RESULTS
75 comparative trials were included in the MA. Regarding global efficacy, PIR was more effective than Naproxen OR=1.37 [1.05; 1.77] and Nabumetone OR=1.72 [1.26; 2.34], while equivalent to other NSAIDS OR=1.06 [0.96; 1.18]. For Pain and swelling, PIR was statistically equivalent to other NSAIDs OR=0.99 [0.80; 1.23] and OR=0.81 [0.48; 1.37]. For mobility, PIR was more effective than Indomethacin, and equivalent to other NSAIDs OR=1.05 [0.80; 1.38]. Patients’ global assessments of efficacy were better for PIR over Naproxen OR=1.41 [1.02; 1.93], and equivalent to the other NSAIDs OR=1.12 [0.98; 1.28]. For global safety, PIR was globally safer than other NSAIDs OR=0.84 [0.73; 0.96], notably Indomethacin OR=0.53 [0.43; 0.64], Naproxen OR=0.75 [0.65; 0.85] and Salicylates OR=0.36 [0.17; 0.75]. For GI safety, PIR was better tolerated than Indomethacin OR=0.46 [0.36; 0.58], Naproxen OR=0.66 [0.53; 0.83] and Salicylates OR=0.45 [0.27; 0.78] while less tolerated than Meloxicam OR=1.49 [1.05; 2.13]. The risk of minor GI effects was less frequent than Naproxen OR=0.66 [0.43; 0.998] and Indomethacin OR=0.51 [0.39; 0.66]. Major GI effects were comparable except for Meloxicam OR=2.37 [1.13; 4.97]. Its skin safety was statistically comparable to comparators OR=1.01 [0.68; 1.51]. The efficacy/safety ratio of PIR was superior to those of Naproxen, Salicylates, and Nabumetone.
CONCLUSIONS
Intrinsic and extrinsic findings support a similar to more favourable profile of Piroxicam as compared to other NSAIDs.
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 F.F. Richy, None; C. Scarpignato, None; A. Lanas, None; G. Singh, None; J. Reginster, None.