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Am Fam Physician. 2018;97(9):573

Author disclosure: No relevant financial affiliations.

Clinical Question

Is celecoxib (Celebrex) effective and safe for patients with rheumatoid arthritis (RA)?

Evidence-Based Answer

Compared with placebo, celecoxib improves pain (number needed to treat [NNT] = 4) and clinical symptoms (NNT = 7), but it has no effect on physical function in patients with RA.1 (Strength of Recommendation [SOR] = A, based on moderate-quality evidence.) Compared with traditional nonsteroidal anti-inflammatory drugs (NSAIDs), celecoxib is no better at improving pain or physical function in patients with RA. Celecoxib causes fewer gastroduodenal ulcers (at least 3 mm in size) than traditional NSAIDs (number needed to harm [NNH] with traditional NSAIDs as opposed to celecoxib = 9).1 (SOR = A, based on moderate-quality evidence.)

Practice Pointers

RA is a common type of inflammatory arthritis. Although disease-modifying antirheumatic drugs (DMARDs) are first-line therapy to minimize pain and swelling, NSAIDs are commonly used for arthritis analgesia. The authors of this review sought to assess whether celecoxib is an effective and safe agent for treating symptoms of RA.1

This review included eight double-blind, randomized, parallel-group trials with 3,988 participants who had been diagnosed with RA for an average of nine years.1 Most patients (73%) were women. Participants in the intervention arms received celecoxib in a dosage of 200 or 400 mg per day. Outcomes were based on American College of Rheumatology 20% improvement criteria (ACR20), as well as self-reported pain and physical function.

Compared with placebo, celecoxib improved clinical symptoms (15% improvement on ACR20; 95% confidence interval [CI], 7% to 25%; NNT = 7 [95% CI, 5 to 13]). Celecoxib also improved self-reported pain (i.e., 11-point reduction on a 100-point visual analog scale over 12 weeks; 95% CI, 8 to 14; NNT = 4 [95% CI, 3 to 6]). Despite these findings, celecoxib did not improve joint function as defined by the Health Assessment Questionnaire Disability Index scale, which assesses activities of daily living in patients with RA. Although the reviewers looked for reports of cardiovascular events, none were noted in the celecoxib vs. placebo comparison. Short-term serious adverse events, such as headache, dyspepsia, diarrhea, and abdominal pain, and total withdrawals or discontinuation rates were evaluated; there was no difference in the rates of short-term serious adverse events between celecoxib and placebo.

Celecoxib and traditional NSAIDs were equally effective at reducing pain and improving clinical symptoms. Moderate-quality evidence showed that celecoxib caused fewer gastroduodenal ulcers (at least 3 mm in size) than traditional NSAIDs (absolute change = 12%; 95% CI, 11% to 13%; NNH = 9 [95% CI, 8 to 10]). No differences were noted in the number of short-term serious adverse events between patients treated with celecoxib and traditional NSAIDs. There were also no differences in cardiovascular events between patients treated with celecoxib and those treated with traditional NSAIDs. Finally, fewer patients discontinued celecoxib therapy (7%) than traditional NSAID therapy (14%; absolute change = 7%; 95% CI, 4% to 9%; NNH = 14 [95% CI, 11 to 23]).

Of note, five out of eight studies in the review were funded by pharmaceutical companies; seven studies were rated as being at high or unclear risk of attrition bias.

There is currently no cure for RA. Although U.S. and Canadian guidelines support the use of DMARDs, they do not discuss the role of NSAIDs for RA. This review suggests there may be a role for the use of celecoxib in the care of RA.2

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