Systematic review and network meta-analysis of different non-steroidal anti-inflammatory drugs for juvenile idiopathic arthritis

ARTICLE HIGHLIGHTS

Research background

Different non-steroidal anti-inflammatory drugs (NSAIDs) have been used for juvenile idiopathic arthritis (JIA), but the best method has not been determined.

Research motivation

To perform a systematic review and network meta-analysis to identify the most effective NSAID for JIA patients.

Research objectives

To perform a systematic review and network meta-analysis to determine the optimal instructions.

Research methods

We searched for randomized controlled trials (RCTs) from PubMed, EMBASE, Google Scholar, CNKI, and Wanfang without restriction for publication date or language at August, 2022. Any RCTs that comparing the effectiveness of NSAIDs with each other or placebo for JIA were included in this network meta-analysis. The surface under the cumulative ranking curve (SUCRA) analysis was used to rank the treatments. P value less than 0.05 was identified as statistically significant.

Research results

Eight RCTs (1127 patients) compared different instructions for NSAIDs, including meloxicam, Celecoxib, piroxicam, Naproxen, inuprofen, Aspirin, Tolmetin, Rofecoxib, and placebo. No significant differences were found in ACR Pedi 30 response between any two NSAIDs. Celecoxib (6 mg/kg bid) had the highest SUCRA ranking at 88.9%, followed by rofecoxib at 68.1% and Celecoxib (3 mg/kg bid) at 51.0%. There were no notable differences in adverse events between NSAIDs. Placebo had the highest ranking, followed by piroxicam, rofecoxib (0.600 mg/kg qd), meloxicam (0.125 mg/kg qd), and rofecoxib (0.300 mg/kg qd).

Research conclusions

In summary, celecoxib (6 mg/kg bid) was found to be the most effective NSAID for treating JIA.

Research perspectives

Rofecoxib, piroxicam, and meloxicam may be safer options, but further research is needed to confirm these findings in larger trials with higher quality studies.