Nine RCTs with 15,187 patients were included in the review.
All nine trials were considered to be of a high quality.
Efficacy.
Three trials were excluded from the analysis of efficacy as the results were not available separately for osteoarthritis and rheumatoid arthritis.
Rheumatoid arthritis (results of >1 favour celecoxib): the results here are for celecoxib versus placebo (2 trials, n=1,373) and celecoxib versus NSAID (3 trials, n=2,019), respectively. The RRs were 1.49 (95% CI: 1.25, 1.78; Q=0.06, p=0.81) and 1.04 (95% CI: 0.80, 1.36; Q=6.94, p=0.03) for ARC-20 improvement; 1.39 (95% CI: 1.21, 1.61; Q=0.37, p=0.54) and 1.09 (95% CI: 0.90, 1.32; Q=6.67, p=0.04) for improvement in the number of painful or tender joints; and 1.34 (95% CI: 1.14, 1.56; Q=0.35, p=0.25) and 1.02 (95% CI: 0.85, 1.22; Q=4.96, p=0.08) for improvement in the number of swollen joints.
Osteoarthritis (results of <0 favour celecoxib): in terms of the WOMAC composite score, the MD was -5.67 (95% CI: -7.45, -3.89; Q=2.26, p=0.32) for celecoxib versus placebo (3 trials, n=1,883) and 0.42 (95% CI: -1.45, 2.30; Q=4.36, p=0.11) for celecoxib versus NSAID (3 trials, n=1,853).
Tolerability (results of <1 favour celecoxib).
For withdrawals due to any adverse effects, the RR was 1.49 (95% CI: 1.15, 1.92; Q=1.08, p=0.90) for celecoxib versus placebo (5 trials, n=3,826) and 0.86 (95% CI: 0.72, 1.04; Q=10.86, p=0.15) for celecoxib versus NSAID (7 trials, n=5,425). For withdrawals due to gastrointestinal adverse effects, the RR was 1.68 (95% CI: 1.07, 2.65; Q=0.32, p=0.99) for celecoxib versus placebo (5 trials, n=3,826) and 0.54 (95% CI: 0.42, 0.71; Q=1.99, p=0.96) for celecoxib versus NSAID (7 trials, n=5,425).
Gastrointestinal safety (results of <1 favour celecoxib).
For ulcers detected by endoscopy, the RR was 1.53 (95% CI: 0.73, 3.21; Q=0.12, p=0.73) for celecoxib versus placebo (2 trials, n=933) and 0.29 (95% CI: 0.21, 0.41; Q=11.33, p=0.05) for celecoxib versus NSAID (5 trials, n=2,742). The trial of celecoxib versus NSAIDs (n=7,968) gave an RR of 0.55 (95% CI: 0.26, 1.14; Q=0.00, p=0.97) for serious upper gastrointestinal events (bleeds, perforations, obstructions) at 24 weeks, and 0.61 (95% CI: 0.39, 0.96; Q=0.66, p=0.42) for serious upper gastrointestinal events plus ulcers at 24 weeks.
Benefits of celecoxib in patients receiving low-dose aspirin (results of <1 favour celecoxib).
For celecoxib versus NSAID (4 trials, n=2,022), the RR was 0.27 (95% CI: 0.16, 0.48; Q=17.79, p=0.001) for no prophylactic aspirin use and 0.49 (95% CI: 0.28, 0.86; Q=3.12, p=0.54) for prophylactic aspirin use.
Further results are available in the review in relation to WOMAC scores of pain, joint stiffness and physical functioning, as well as withdrawals due to adverse events.