Celecoxib compared with sustained release paracetamol for osteoarthritis: a series of n-of-1 trials

Yelland, M. J., Nikles, C. J., McNairn, N., Del Mar, C. B., Schluter, P. J. and Brown, R. M. (2007) Celecoxib compared with sustained release paracetamol for osteoarthritis: a series of n-of-1 trials. Rheumatology, 46 1: 135-140.


Author Yelland, M. J.
Nikles, C. J.
McNairn, N.
Del Mar, C. B.
Schluter, P. J.
Brown, R. M.
Title Celecoxib compared with sustained release paracetamol for osteoarthritis: a series of n-of-1 trials
Journal name Rheumatology   Check publisher's open access policy
ISSN 1462-0324
Publication date 2007-01
Sub-type Article (original research)
DOI 10.1093/rheumatology/kel195
Volume 46
Issue 1
Start page 135
End page 140
Total pages 6
Editor R. A. Watts
Place of publication Oxford, U.K.
Publisher Oxford University Press
Collection year 2008
Language eng
Subject 321099 Clinical Sciences not elsewhere classified
C1
730114 Skeletal system and disorders (incl. arthritis)
Formatted abstract Objective.
To assess the use of n-of-1 trials for short-term choice of drugs for osteoarthritis, with particular reference to
comparing the efficacy of sustained-release [SR] paracetamol with celecoxib in individual patients.

Methods.
Evaluation of community-based patients undergoing n-of-1 trials which consisted of double-blind, crossover
comparisons of celecoxib 200 or 400 mg/day with sustained-release paracetamol 1330 mg three times a day in three pairs of
2 week treatment periods per drug with random order of the drugs within pairs. Outcomes evaluated were pain and stiffness
in sites nominated by the patient, functional limitation scores, preferred medication, side effects and changes in drug use after an
n-of-1 trial. Participants were 59 patients with osteoarthritis in multiple sites (hip 6, knee 24, hand 6, shoulder/neck 8, back 14,
foot 5), with pain for 1 month severe enough to warrant consideration of long-term use of celecoxib but for whom there was
doubt about its efficacy. Forty-one n-of-1 trials were completed.

Results.

Although on average, celecoxib showed better scores than SR paracetamol [0.2 (0.1) for pain, 0.3 (0.1) for stiffness and
0.3 (0.1) for functional limitation], 33 of the 41 individual patients (80%) failed to identify the differences between SR
paracetamol and celecoxib in terms of overall symptom relief. Of the eight patients who were able to identify the differences,
seven had better relief with celecoxib and one with SR paracetamol. In 25 out of 41 [61%] patients, subsequent management
was consistent with their trial results.

Conclusions
.
N-of-1 trials may provide a rational and effective method to best choose drugs for individuals with osteoarthritis.
SR paracetamol is more useful than celecoxib for most patients of whom management is uncertain.
Keyword n-of-1 trials
osteoarthritis
celecoxib
SR paracetamol
Q-Index Code C1
Q-Index Status Confirmed Code

 
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