Meta-Analysis
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 26, 2024; 12(12): 2056-2064
Published online Apr 26, 2024. doi: 10.12998/wjcc.v12.i12.2056
Systematic review and network meta-analysis of different non-steroidal anti-inflammatory drugs for juvenile idiopathic arthritis
Tao Zeng, Jian-Zhong Ye, Hui Qin, Qian-Qian Xu
Tao Zeng, Jian-Zhong Ye, Hui Qin, Qian-Qian Xu, College of Medicine, Jingchu University of Technology Jingmen, Jingmen 448000, Hubei Province, China
Author contributions: Zeng T and Ye JZ conceived and designed the study; Qin H searched and selected relevant studies; Xu QQ and Zeng T extracted and interpreted data; and all authors critically reviewed and approved the final manuscript.
Supported by the Science and Technology Plan Project of Jingmen Science and Technology Bureau, No. 2018YFZD025.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qian-Qian Xu, MD, Senior Statistician, College of Medicine, Jingchu University of Technology Jingmen, No. 33 Xiangshan Road, Jingmen 448000, Hubei Province, China. yanfenjiu19940211@163.com
Received: September 22, 2023
Peer-review started: September 22, 2023
First decision: December 15, 2023
Revised: January 23, 2024
Accepted: March 1, 2024
Article in press: March 1, 2024
Published online: April 26, 2024
Processing time: 206 Days and 16.3 Hours
Abstract
BACKGROUND

Various non-steroidal anti-inflammatory drugs (NSAIDs) have been used for juvenile idiopathic arthritis (JIA). However, the optimal method for JIA has not yet been developed.

AIM

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

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, 2023. 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.

RESULTS

We included 8 RCTs (1127 patients) comparing 8 different instructions including meloxicam (0.125 qd and 0.250 qd), Celecoxib (3 mg/kg bid and 6 mg/kg bid), piroxicam, Naproxen (5.0 mg/kg/d, 7.5 mg/kg/d and 12.5 mg/kg/d), inuprofen (30-40 mg/kg/d), Aspirin (60-80 mg/kg/d, 75 mg/kg/d, and 55 mg/kg/d), Tolmetin (15 mg/kg/d), Rofecoxib, and placebo. There were no significant differences between any two NSAIDs regarding ACR Pedi 30 response. The SUCRA shows that celecoxib (6 mg/kg bid) ranked first (SUCRA, 88.9%), rofecoxib ranked second (SUCRA, 68.1%), Celecoxib (3 mg/kg bid) ranked third (SUCRA, 51.0%). There were no significant differences between any two NSAIDs regarding adverse events. The SUCRA shows that placebo ranked first (SUCRA, 88.2%), piroxicam ranked second (SUCRA, 60.5%), rofecoxib (0.6 mg/kg qd) ranked third (SUCRA, 56.1%), meloxicam (0.125 mg/kg qd) ranked fourth (SUCRA, 56.1%), and rofecoxib (0.3 mg/kg qd) ranked fifth (SUCRA, 56.1%).

CONCLUSION

In summary, celecoxib (6 mg/kg bid) was found to be the most effective NSAID for treating JIA. Rofecoxib, piroxicam, and meloxicam may be safer options, but further research is needed to confirm these findings in larger trials with higher quality studies.

Keywords: Non-steroidal anti-inflammatory drugs; Juvenile idiopathic arthritis; Network meta-analysis; Systematic review

Core Tip: In summary, celecoxib (6 mg/kg bid) was found to be the most effective non-steroidal anti-inflammatory drug for treating juvenile idiopathic arthritis. Rofecoxib, piroxicam, and meloxicam may be safer options, but further research is needed to confirm these findings in larger trials with higher quality studies.