J Rheum Dis 2017; 24(5): 293-302  
Cardiovascular and Gastrointestinal Effects of Etoricoxib in the Treatment of Osteoarthritis: A Systematic Review and Network Meta-analysis
Dam Kim1, Soo-Kyung Cho1, Seoung Wan Nam1, Hyuk Hee Kwon1, Sun-Young Jung2, Chan Hong Jeon3, Seul Gi Im4, Dalho Kim4, Eun Jin Jang5, Yoon-Kyoung Sung1
1Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 2College of Pharmacy, Chung-Ang University, Seoul, 3Division of Rheumatology, Department of Internal Medicine, Soon Chun Hyang University Bucheon Hospital, Bucheon, 4Department of Statistics, Kyungpook National University, Daegu, 5Department of Information Statistics, Andong National University, Andong, Korea
Correspondence to: Yoon-Kyoung Sung, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea. E-mail:sungyk@hanyang.ac.kr
Received: August 31, 2017; Revised: October 7, 2017; Accepted: October 8, 2017; Published online: October 31, 2017.
© Korean College of Rheumatology. All rights reserved.

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Abstract
Objective. To estimate the cardiovascular (CV) and gastrointestinal (GI) risks of etoricoxib in the treatment of osteoarthritis (OA) compared to a placebo and other non-steroidal anti-inflammatory drugs (NSAIDs). Methods. A systematic review of randomized, controlled trials (RCTs) of etoricoxib were performed. Bayesian network meta-analysis was used over a duration of 12 weeks. The incidence of CV and GI events for a duration ≥26 weeks were also tabulated and presented using descriptive statistics. Results. From this search, 10 studies were identified. Of these, 6 and 5 RCTs that measured the CV and GI events at 12 weeks were included in meta-analysis. They showed that etoricoxib did not increase the CV events compared to the placebo or NSAIDs during the 12 week period (odds ratio [OR]=0.59 compared to celecoxib, OR=0.89 with ibuprofen, OR=0.70 with placebo, and OR=2.16 with naproxen). The risk of GI events was comparable to that of most comparators, with the exception of naproxen, which had a significantly lower risk of GI events (OR=0.18) during the 12 week period. For a duration ≥26 weeks, the incidence of CV and GI events with etoricoxib increased with increasing duration. Conclusion. Etoricoxib is an alternative short-term treatment option for OA, showing comparable CV and GI complications to other NSAIDs. Nevertheless, further studies will be needed to elucidate the long-term safety of etoricoxib in the treatment of OA.
Keywords: Anti-inflammatory agents, non-steroidal, Etoricoxib, Osteoarthritis, Safety


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