Gastrointestinal safety of etoricoxib in osteoarthritis and rheumatoid arthritis: A meta-analysis

<div><p>Objective</p><p>To ascertain if etoricoxib increases the risk of gastrointestinal adverse events (GAEs) compared with placebo, diclofenac, and naproxen in the treatment of patients with osteoarthritis (OA) or rheumatoid arthritis (RA).</p><p>Methods</p><p>Studies were searched in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials from inception to August 2017. Randomized Clinical Trials (RCTs) that compared etoricoxib with placebo and other active drug for patients with OA or RA and reported data on gastrointestinal safety (which is of interest to patients and clinicians) were included. The follow-up time window for GAEs was defined as within 28 days subsequent to the last dose of study medication. A meta-analysis was conducted using a fixed-effect model. Risk ratios (RRs) and 95% confidence intervals (CIs) were measured.</p><p>Results</p><p>We found nine randomized clinical trials (RCTs) that included information on gastrointestinal safety during follow-up time. Among them, five RCTs compared etoricoxib with placebo, four RCTs compared etoricoxib with diclofenac, and three RCTs compared etoricoxib with naproxen. Etoricoxib did not increase the risk of GAEs compared with placebo. Compared with diclofenac and naproxen, etoricoxib reduced the GAE risk (RR, 0.67; 95% CI, 0.59–0.76; p < 0.00001; 0.59; 0.48–0.72; < 0.00001) during follow-up time.</p><p>Conclusions</p><p>In patients with OA or RA, etoricoxib did not increase the GAE risk compared with placebo, but reduced the GAE risk effectively compared with diclofenac and naproxen during follow-up time.</p></div

Funnel plot of publication bias for etoricoxib compared with placebo, diclofenac, and naproxen.

<p>Funnel plot of publication bias for etoricoxib compared with placebo, diclofenac, and naproxen.</p

Incidence of confirmed adverse events of gastrointestinal (GI) safety.

<p>Incidence of confirmed adverse events of gastrointestinal (GI) safety.</p

Flow-chart of study selection process.

<p>Flow-chart of study selection process.</p

Characteristics of included trials.

<p>Characteristics of included trials.</p

Proteomic analysis identifies MMP-9, DJ-1 and A1BG as overexpressed proteins in pancreatic juice from pancreatic ductal adenocarcinoma patients-4

05). PDAC: pancreatic ductal adenocarcinoma patients; CP: chronic pancreatitis patients; N: healthy controls.<p><b>Copyright information:</b></p><p>Taken from "Proteomic analysis identifies MMP-9, DJ-1 and A1BG as overexpressed proteins in pancreatic juice from pancreatic ductal adenocarcinoma patients"</p><p>http://www.biomedcentral.com/1471-2407/8/241</p><p>BMC Cancer 2008;8():241-241.</p><p>Published online 16 Aug 2008</p><p>PMCID:PMC2528014.</p><p></p

Proteomic analysis identifies MMP-9, DJ-1 and A1BG as overexpressed proteins in pancreatic juice from pancreatic ductal adenocarcinoma patients-5

). Labeled spots are significantly up-regulated proteins in pancreatic cancer juice (A), in cancer-free controls juice (B) and a total of 24 differentially expressed protein spots (C).<p><b>Copyright information:</b></p><p>Taken from "Proteomic analysis identifies MMP-9, DJ-1 and A1BG as overexpressed proteins in pancreatic juice from pancreatic ductal adenocarcinoma patients"</p><p>http://www.biomedcentral.com/1471-2407/8/241</p><p>BMC Cancer 2008;8():241-241.</p><p>Published online 16 Aug 2008</p><p>PMCID:PMC2528014.</p><p></p

Proteomic analysis identifies MMP-9, DJ-1 and A1BG as overexpressed proteins in pancreatic juice from pancreatic ductal adenocarcinoma patients-6

<p><b>Copyright information:</b></p><p>Taken from "Proteomic analysis identifies MMP-9, DJ-1 and A1BG as overexpressed proteins in pancreatic juice from pancreatic ductal adenocarcinoma patients"</p><p>http://www.biomedcentral.com/1471-2407/8/241</p><p>BMC Cancer 2008;8():241-241.</p><p>Published online 16 Aug 2008</p><p>PMCID:PMC2528014.</p><p></p

Proteomic analysis identifies MMP-9, DJ-1 and A1BG as overexpressed proteins in pancreatic juice from pancreatic ductal adenocarcinoma patients-2

9 expression evinced both 92 kDa and 82 kDa bands, corresponding to the latent and activated forms of MMP-9, respectively.<p><b>Copyright information:</b></p><p>Taken from "Proteomic analysis identifies MMP-9, DJ-1 and A1BG as overexpressed proteins in pancreatic juice from pancreatic ductal adenocarcinoma patients"</p><p>http://www.biomedcentral.com/1471-2407/8/241</p><p>BMC Cancer 2008;8():241-241.</p><p>Published online 16 Aug 2008</p><p>PMCID:PMC2528014.</p><p></p

Proteomic analysis identifies MMP-9, DJ-1 and A1BG as overexpressed proteins in pancreatic juice from pancreatic ductal adenocarcinoma patients-0

). Labeled spots are significantly up-regulated proteins in pancreatic cancer juice (A), in cancer-free controls juice (B) and a total of 24 differentially expressed protein spots (C).<p><b>Copyright information:</b></p><p>Taken from "Proteomic analysis identifies MMP-9, DJ-1 and A1BG as overexpressed proteins in pancreatic juice from pancreatic ductal adenocarcinoma patients"</p><p>http://www.biomedcentral.com/1471-2407/8/241</p><p>BMC Cancer 2008;8():241-241.</p><p>Published online 16 Aug 2008</p><p>PMCID:PMC2528014.</p><p></p