Seventy-five RCTs with 33,286 participants were included. Twenty-one were rated good to excellent for quality (Jadad score 4 or 5). None of the methods used suggested the presence of significant publication bias.
Efficacy: Overall, piroxicam did not differ significantly from all other non-steroidal anti-inflammatory drugs (NSAIDs) combined for dichotomous global efficacy outcomes (OR 1.06, 95% confidence interval (CI) 0.96 to 1.18). Piroxicam was significantly superior to naproxen (OR 1.37, 95% CI 1.05 to 1.77; 14 RCTs). Results for specific outcomes were reported.
Safety: For dichotomous safety outcomes (i.e. occurrence of adverse events), piroxicam was significantly superior to other NSAIDs overall (OR 0.83, 95% CI 0.73 to 0.95) and for gastrointestinal outcomes (OR 0.74, 95% CI 0.59 to 0.93). Major gastrointestinal events were not significantly more common with piroxicam than other NSAIDs, with the exception of meloxicam (OR 2.37, 95% CI 1.13 to 4.97, five RCTs). None of the included trials reported on cardiovascular safety.