治疗急性痛风的选择性环氧化酶-2 抑制剂和非选择性非甾体抗炎药物的系统回顾和 Meta 分析

Swathy Govindaswamy, Kavya Ponnusamy, Indhumathi *S., Vineeth Anil, Jayalakshmi Venugopal, Dhivya P. Sundaram
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摘要

背景:"痛风 "一词是指由于血清尿酸盐浓度升高而影响患者多个关节的广泛临床疾病,包括常见和复杂形式的关节炎。目的:本研究旨在比较选择性环氧化酶-2(COX-2)抑制剂和非选择性非甾体抗炎药(NSAIDs)治疗急性痛风的疗效和安全性,并对安全性进行荟萃分析。研究方法截至 2021 年 12 月,使用 PubMed、Embase、Web of Science 和 Cochrane Library 等授权电子数据库进行文献检索。结果本研究结果共纳入了七项调查。据报道,三种 COX-2 抑制剂(依托考昔、塞来昔布和美洛昔康)与吲哚美辛或双氯芬酸进行了比较。首次用药四小时后,120 毫克依托考昔可通过减少红斑来减轻疼痛和炎症。较高剂量的塞来昔布比较低剂量的塞来昔布更有效。美洛昔康的疗效与非甾类抗炎药相同。亚组分析显示,COX-2 抑制剂组发生不良事件的风险比非选择性非甾体抗炎药组低 8.0%(风险比 = 0.92,95% 置信区间 = 0.60 至 0.40,P 值 = 0.5)。结论COX-2抑制剂依托考昔的作用更强,可能比非选择性非甾体抗炎药更有效。与非选择性非甾体抗炎药相比,COX-2 抑制剂的耐受性更好,能更有效地降低胃肠道不良反应的风险。在痛风的治疗中,非选择性非甾体抗炎药可能是 COX-2 抑制剂的合适替代品。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A Systematic Review and Meta-analysis of Selective Cyclooxygenase-2 Inhibitors and Non-selective Non-steroidal Anti-inflammatory Drugs for Acute Gout
Background:The term “gout” refers to a broad clinical spectrum of diseases, including common and complex forms of arthritis, that affect multiple joints in a patient due to an elevated serum urate concentration. Purpose: The study aims to compare the efficacy and safety of selective cyclooxygenase-2 (COX-2) inhibitors and non-selective nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment of acute gout, as well as to conduct a meta-analysis on safety. Methods: As of December 2021, the literature search was conducted using authorised electronic databases such as PubMed, Embase, Web of Science, and the Cochrane Library. Results: There were seven investigations included in this study’s findings. Three COX-2 inhibitors, etoricoxib, celecoxib, and meloxicam, were reportedly compared to indomethacin or diclofenac. Four hours after the initial dose, 120 mg of etoricoxib reduces pain and inflammation by diminishing erythema. At higher dosages, celecoxib is more effective than at lower doses. Meloxicam has the same efficacy as NSAIDs. The subgroup analysis revealed that the risk of adverse events was 8.0% lower in the COX-2 inhibitors group than in the non-selective NSAIDs group (risk ratio = 0.92, 95% confidence interval = 0.60 to 0.40, p-value = 0.5). Conclusion: Etoricoxib, a COX-2 inhibitor, has a more potent effect and may be more effective than nonselective NSAIDs. COX-2 inhibitors are more well tolerated and reduce the risk of adverse gastrointestinal events more effectively than nonselective NSAIDs. In the treatment of gout, nonselective NSAIDs may be a suitable alternative to COX-2 inhibitors.
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