Authors' objectives: The objective of this review was to present the current evidence on the efficacy/effectiveness and safety of celecoxib (Celebrex (R)) for the treatment of pain in patients with osteoarthritis (OA) and rheumatoid arthritis (RA).

Authors' results and conclusions: Two SRs (meta-analyses) of RCTs assessed the effectiveness (pain reduction and functional improvement) and safety (endoscopic evaluation, gastric/duodenal erosions or ulcers) of celecoxib administered to patients who have OA and RA. At three months follow-up, celecoxib at any dose (80 mg to 800 mg) showed a statistically significant (SS) improvement compared with placebo in patients with RA. At 400 mg daily for three months, celecoxib, when compared with naproxen 1000 mg daily, showed a SS improvement only on the basis of patient.s and physician.s global assessments. At six months, celecoxib 400 mg daily was just as effective as diclofenac 150 mg daily. As determined by endoscopic evaluation, gastroduodenal erosions or ulcers were significantly reduced in RA and OA patients after taking 400 mg daily of celecoxib compared with diclofenac (150 mg daily) after six months, and naproxen (1000 mg daily) and ibuprofen (2400 mg daily) after three months. Five RCTs were located that assessed the outcomes of celecoxib administered to patients with OA of the knee and/or hip and patients with RA. Celecoxib 200 mg daily showed the same efficacy when compared with different active drugs (COX-2 inhibitors, nimesulide 100 mg daily and rofecoxib 25 mg daily; or diclofenac 150 mg daily), was superior to acetaminophen 1,000 mg four times daily, and provided a SS improvement when compared with placebo in patients with OA for periods of follow-up between two weeks and one year. The safety analysis indicated that celecoxib 800 mg daily was superior in dyspepsia tolerability compared with diclofenac 150 mg daily. Celecoxib 200 mg daily showed a similar safety profile when compared with other active treatments (selective and non-selective NSAIDs). None of the RCTs investigated gastroduodenal erosions or ulcers.

Authors' recommendations: Overall, short-term use of celecoxib was equivalent to non-selective NSAIDs (naproxen and diclofenac) and other COX-2 inhibitors (nimesulide and rofecoxib) and was superior to acetaminophen in reducing pain and improving function for patients with RA and OA. Short-term use of celecoxib was associated with a reduction in rates of gastroduodenal erosions or ulcers compared with those for non-selective NSAIDs (naproxen, ibuprofen, and diclofenac) in patients with RA and OA. Many questions remain to be addressed about the long-term safety of celecoxib compared with non-selective NSAIDs and about the combination treatment of NSAIDs and other types of drugs. Health Canada recommended usage restrictions for Celebrex beginning in April 2005. Celebrex should not be used in patients who have had a heart attack or stroke, serious chest pain related to hearth disease, or congestive heart failure. Celebrex may increase the risk of cardiovascular events in patients with high blood pressure, high cholesterol, diabetes, and smoking. Also, Celebrex should be prescribed and used at the lowest possible dose and for the shortest, necessary period of time.

Authors' methods: Review

Project Status: Completed

Year Published: 2005

URL for published report: http://www.ihe.ca/advanced-search/celecoxib-for-the-treatment-of-pain-in-osteoarthritis-and-rheumatoid-arthritis

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Institute of Health Economics

Contact Address: 1200, 10405 Jasper Avenue, Edmonton, Alberta, Canada, T5J 3N4. Tel: +1 780 448 4881; Fax: +1 780 448 0018;

Contact Name: djuzwishin@ihe.ca

Contact Email: djuzwishin@ihe.ca

Copyright: <p>Alberta Heritage Foundation for Medical Research (AHFMR)</p>