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Effect of nonsteroidal antiinflammatory drugs on C-reactive protein in rheumatoid arthritis: A meta-analysis of randomized controlled trials
Arthritis & Rheumatism, 07/31/2012
Evidence Based Medicine
Clinical Article
Tarp S et al. – Nonsteroidal antiinflammatory drugs (NSAIDs) have no effect on C–reactive protein (CRP). However, the non–selective NSAID naproxen was associated with a significant decrease in CRP, whereas the cyclooxygenase–2 selective NSAID lumiracoxib was associated with a significant increase in CRP. This is interesting in relation to NSAIDs' suspected influence on cardio–vascular complications.
Methods- A systematic search in MEDLINE, EMBASE, Web of Science, Cochrane CENTRAL, and other sources was performed.
- Eligible trials were parallel-group randomized placebo-controlled trials of oral NSAID therapy in RA patients with extractable CRP data.
- Standardized mean differences (SMDs) were calculated from the differences in means of CRP between groups (active - placebo) divided by the pooled standard deviations (SD).
- For the meta-analysis, a random-effects model was used to estimate the overall change in CRP as well as stratified analysis to examine differences among NSAIDs.
- 19 trials of 10 different NSAIDs were included.
- Overall, NSAIDs showed no effect on the CRP level (SMD 0.01 [95% CI, -0.03, 0.06]; P=0.62).
- The pre-specified stratified analysis, however, indicated varying effects on CRP according to the different NSAIDs; lumiracoxib caused a statistically significant and consistent (I2 = 0%) increase in the CRP level (SMD 0.13 [95% CI, 0.01, 0.25]; P=0.037), whereas naproxen caused a statistically significant and consistent (I2 = 0%) decrease in the CRP level (SMD -0.11 [95% CI, -0.20, -0.02]; P=0.022).