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

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Title Celecoxib compared with sustained-release paracetamol for osteoarthritis: a series of n-of-1 trials
Author Yelland, Michael; Nikles, C. J.; McNairn, N.; Mar, C. B. Del; Schluter, P. J.; Brown, R. M.
Journal Name Rheumatology
Editor R A Watts
Year Published 2007
Place of publication United Kingdom
Publisher Oxford University Press
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.
Peer Reviewed Yes
Published Yes
Publisher URI http://rheumatology.oxfordjournals.org/
Alternative URI http://dx.doi.org/10.1093/rheumatology/kel195
Copyright Statement Copyright The Author 2006. Published by Oxford University Press on behalf of the British Society for Rheumatology. Please refer to the link for the definitive publisher-authenticated version.
Volume 46
Issue Number 1
Page from 135
Page to 140
ISSN 1462-0324
Date Accessioned 2007-03-12
Language en_AU
Research Centre Griffith Health Institute; Centre for Musculoskeletal Research
Faculty Griffith Health Faculty
Subject PRE2009-Primary Health Care
URI http://hdl.handle.net/10072/15035
Publication Type Journal Articles (Refereed Article)
Publication Type Code c1

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