A study to determine the efficacy and safety of tenoxicam versus piroxicam, diclofenac and indomethacin in patients with osteoarthritis: a meta-analysis.
OBJECTIVE
To obtain a better quantitative and qualitative estimate of the effect of tenoxicam (Tx) compared to piroxicam (Px), diclofenac (Dcl) and indomethacin (Ind) in the treatment of osteoarthritis (OA).


METHODS
Relevant studies were identified using computerized Medline search, manual search of cited references and correspondence with investigators, colleagues and the manufacturer of Tx. Once the studies were selected and chosen on the basis of predetermined methodologic criteria, the required data were extracted by 2 authors, independently. Eighteen studies met the required eligibility criteria. Meta-analyses were undertaken on 12 studies of Tx vs Px, 3 studies of Tx vs Dcl, and 2 studies of Tx vs Ind. Efficacy was measured in 2 ways: (1) physician global rating scale and (2) pain scale. Safety was measured in 3 ways: (1) physician global rating scale, (2) number of patients with adverse events, and (3) dropouts due to adverse events.


RESULTS
The following findings of the meta-analysis were statistically significant: In Tx vs Px comparisons, efficacy-(1), safety-(1) and safety-(3) were all better with Tx; in Tx vs Ind comparisons, safety-(1) and safety-(2) were better with Tx. All other findings showed no statistically significant differences between Tx and the comparison drug.


CONCLUSIONS
Compared to Px, Tx performs better on physician assessment of efficacy and tolerability, but the other comparisons remain inconclusive. Compared to Dcl, there appears not to be a difference. Compared to Ind, Tx is safer.
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
P J
PJ
Riedemann
S
S
Bersinic
L J
LJ
Cuddy
G W
GW
Torrance
P X
PX
Tugwell
D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000592:standards* / Q000627:therapeutic use; D004008:Diclofenac / Q000009:adverse effects* / Q000592:standards* / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007213:Indomethacin / Q000009:adverse effects* / Q000592:standards* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000188:drug therapy*; D010894:Piroxicam / Q000009:adverse effects* / Q000031:analogs & derivatives* / Q000592:standards* / Q000627:therapeutic use; D011897:Random Allocation
D000894:Anti-Inflammatory Agents, Non-Steroidal; D010894:Piroxicam; D004008:Diclofenac; D007213:Indomethacin; C032801:tenoxicam