100 cases in acute medicine:
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Acetaminophen did not have a clinically significant effect for the treatment of osteoarthritis (OA) pain in this meta-analysis of 76 randomized clinical trials (RCTs).
Why this matters:
NSAIDs are a mainstay of OA treatment, but drug selection in light of risks and polypharmacy can be difficult.
Diclofenac 150 mg/d was the most effective intervention for pain and physical function.
Etoricoxib 60 mg/d or rofecoxib 25 mg/d also made a clinically important difference.
All NSAIDs displayed significant gastrointestinal and cardiovascular harm.
Acetaminophen did not have a clinically significant effect vs placebo at any dose.
Network meta-analysis of 76 RCTs (n=58,451) that compared varying NSAID doses head-to-head or vs placebo or acetaminophen for hip or knee OA.
Most follow-up durations were ≤3 mo.Most trials were of high quality.
Primary outcome was pain.
Swiss National Science Foundation;
Arco Foundation, Switzerland.
Many RCTs found to be at risk for some form of bias.
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