Comparative pain reduction of oral non-steroidal anti-inflammatory drugs and opioids for knee osteoarthritis: systematic analytic review S.R. Smith,

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Presentation transcript:

Comparative pain reduction of oral non-steroidal anti-inflammatory drugs and opioids for knee osteoarthritis: systematic analytic review S.R. Smith, B.R. Deshpande, J.E. Collins, J.N. Katz, E. Losina Osteoarthritis and Cartilage Volume 24, Issue 6, Pages 962-972 (June 2016) DOI: 10.1016/j.joca.2016.01.135 Copyright © 2016 Osteoarthritis Research Society International Terms and Conditions

Fig. 1 One study included both NSAIDs and opioids treatment groups and is represented in both arms in this figure. Osteoarthritis and Cartilage 2016 24, 962-972DOI: (10.1016/j.joca.2016.01.135) Copyright © 2016 Osteoarthritis Research Society International Terms and Conditions

Fig. 2 This figure displays the funnel plot of precision (reciprocal of the variance) by mean change from baseline, modified for efficacy-related withdrawals, in WOMAC Pain for all included studies of (a) NSAIDs and (b) opioids. The NSAIDs funnel plot appears fairly symmetrical, and Egger's test was not statistically significant (P = 0.50). The opioids funnel plot is asymmetrical, with more studies reporting more change and fewer studies with lower precision reporting less change; Egger's test was borderline statistically significant (P = 0.05). The dashed lines represent combined efficacy estimates from a random effects model of the two classes of analgesics (NSAIDs: −18; opioids: −19). Osteoarthritis and Cartilage 2016 24, 962-972DOI: (10.1016/j.joca.2016.01.135) Copyright © 2016 Osteoarthritis Research Society International Terms and Conditions

Fig. 3 This figure portrays the mean change from baseline, modified for efficacy-related withdrawals, in WOMAC Pain (with 95% confidence intervals [CIs]) for all included studies of (a) NSAIDs, (b) less potent opioids, and (c) potent opioids. Osteoarthritis and Cartilage 2016 24, 962-972DOI: (10.1016/j.joca.2016.01.135) Copyright © 2016 Osteoarthritis Research Society International Terms and Conditions

Fig. 4 The trim and fill method was utilized to impute hypothetical missing publications (indicated with a dash) for less potent opioids, as the funnel plot initially exhibited significant asymmetry. Though the peak remains uncentered, the plot is more symmetric and Egger's test is not statistically significant (P = 0.57). Osteoarthritis and Cartilage 2016 24, 962-972DOI: (10.1016/j.joca.2016.01.135) Copyright © 2016 Osteoarthritis Research Society International Terms and Conditions

Fig. 5 This figure depicts the direct and indirect comparisons between NSAIDs, less potent opioids, potent opioids, and placebo treatment arms among included studies. Osteoarthritis and Cartilage 2016 24, 962-972DOI: (10.1016/j.joca.2016.01.135) Copyright © 2016 Osteoarthritis Research Society International Terms and Conditions