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'Risk of bias' graph: review authors' judgements about each methodological quality item presented as percentages across all included studies
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Figure 1

'Risk of bias' graph: review authors' judgements about each methodological quality item presented as percentages across all included studies

'Risk of bias' summary: review authors' judgements about each methodological quality item for each included study
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Figure 2

'Risk of bias' summary: review authors' judgements about each methodological quality item for each included study

Comparison 1 NSAIDs versus placebo, global effect, Outcome 1 Sum of overall symptom score (random‐effects model).
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Analysis 1.1

Comparison 1 NSAIDs versus placebo, global effect, Outcome 1 Sum of overall symptom score (random‐effects model).

Comparison 1 NSAIDs versus placebo, global effect, Outcome 2 Moderate to marked severity.
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Analysis 1.2

Comparison 1 NSAIDs versus placebo, global effect, Outcome 2 Moderate to marked severity.

Comparison 1 NSAIDs versus placebo, global effect, Outcome 3 Duration of colds (random‐effects model).
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Analysis 1.3

Comparison 1 NSAIDs versus placebo, global effect, Outcome 3 Duration of colds (random‐effects model).

Comparison 1 NSAIDs versus placebo, global effect, Outcome 4 Duration of restriction of daily activities.
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Analysis 1.4

Comparison 1 NSAIDs versus placebo, global effect, Outcome 4 Duration of restriction of daily activities.

Comparison 2 NSAIDs versus placebo, analgesic effect, Outcome 1 Throat irritation score (fixed‐effect model).
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Analysis 2.1

Comparison 2 NSAIDs versus placebo, analgesic effect, Outcome 1 Throat irritation score (fixed‐effect model).

Comparison 2 NSAIDs versus placebo, analgesic effect, Outcome 2 Headache score (random‐effects model).
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Analysis 2.2

Comparison 2 NSAIDs versus placebo, analgesic effect, Outcome 2 Headache score (random‐effects model).

Comparison 2 NSAIDs versus placebo, analgesic effect, Outcome 3 Score of pain in muscles/joints score (fixed‐effect model).
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Analysis 2.3

Comparison 2 NSAIDs versus placebo, analgesic effect, Outcome 3 Score of pain in muscles/joints score (fixed‐effect model).

Comparison 2 NSAIDs versus placebo, analgesic effect, Outcome 4 Malaise score (fixed‐effect model).
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Analysis 2.4

Comparison 2 NSAIDs versus placebo, analgesic effect, Outcome 4 Malaise score (fixed‐effect model).

Comparison 2 NSAIDs versus placebo, analgesic effect, Outcome 5 Chilliness score (random‐effects model).
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Analysis 2.5

Comparison 2 NSAIDs versus placebo, analgesic effect, Outcome 5 Chilliness score (random‐effects model).

Comparison 2 NSAIDs versus placebo, analgesic effect, Outcome 6 Nose irritation score.
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Analysis 2.6

Comparison 2 NSAIDs versus placebo, analgesic effect, Outcome 6 Nose irritation score.

Comparison 2 NSAIDs versus placebo, analgesic effect, Outcome 7 Score of pain on swallowing.
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Analysis 2.7

Comparison 2 NSAIDs versus placebo, analgesic effect, Outcome 7 Score of pain on swallowing.

Comparison 2 NSAIDs versus placebo, analgesic effect, Outcome 8 Eye itching score.
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Analysis 2.8

Comparison 2 NSAIDs versus placebo, analgesic effect, Outcome 8 Eye itching score.

Comparison 2 NSAIDs versus placebo, analgesic effect, Outcome 9 Earache score.
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Analysis 2.9

Comparison 2 NSAIDs versus placebo, analgesic effect, Outcome 9 Earache score.

Comparison 3 NSAIDs versus placebo, non‐analgesic effect, Outcome 1 Cough score (random‐effects model).
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Analysis 3.1

Comparison 3 NSAIDs versus placebo, non‐analgesic effect, Outcome 1 Cough score (random‐effects model).

Comparison 3 NSAIDs versus placebo, non‐analgesic effect, Outcome 2 Sneezing score (fixed‐effect model).
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Analysis 3.2

Comparison 3 NSAIDs versus placebo, non‐analgesic effect, Outcome 2 Sneezing score (fixed‐effect model).

Comparison 3 NSAIDs versus placebo, non‐analgesic effect, Outcome 3 Total number of sneezes.
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Analysis 3.3

Comparison 3 NSAIDs versus placebo, non‐analgesic effect, Outcome 3 Total number of sneezes.

Comparison 3 NSAIDs versus placebo, non‐analgesic effect, Outcome 4 Rhinorrhoea score (fixed‐effect model).
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Analysis 3.4

Comparison 3 NSAIDs versus placebo, non‐analgesic effect, Outcome 4 Rhinorrhoea score (fixed‐effect model).

Comparison 3 NSAIDs versus placebo, non‐analgesic effect, Outcome 5 Nasal obstruction score (fixed‐effect model).
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Analysis 3.5

Comparison 3 NSAIDs versus placebo, non‐analgesic effect, Outcome 5 Nasal obstruction score (fixed‐effect model).

Comparison 3 NSAIDs versus placebo, non‐analgesic effect, Outcome 6 Nasal obstruction score > 5.
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Analysis 3.6

Comparison 3 NSAIDs versus placebo, non‐analgesic effect, Outcome 6 Nasal obstruction score > 5.

Comparison 3 NSAIDs versus placebo, non‐analgesic effect, Outcome 7 Total number of nose blows.
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Analysis 3.7

Comparison 3 NSAIDs versus placebo, non‐analgesic effect, Outcome 7 Total number of nose blows.

Comparison 3 NSAIDs versus placebo, non‐analgesic effect, Outcome 8 Total mucus weight.
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Analysis 3.8

Comparison 3 NSAIDs versus placebo, non‐analgesic effect, Outcome 8 Total mucus weight.

Comparison 3 NSAIDs versus placebo, non‐analgesic effect, Outcome 9 Total tissue number count.
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Analysis 3.9

Comparison 3 NSAIDs versus placebo, non‐analgesic effect, Outcome 9 Total tissue number count.

Comparison 3 NSAIDs versus placebo, non‐analgesic effect, Outcome 10 Score of dryness in the nose.
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Analysis 3.10

Comparison 3 NSAIDs versus placebo, non‐analgesic effect, Outcome 10 Score of dryness in the nose.

Comparison 3 NSAIDs versus placebo, non‐analgesic effect, Outcome 11 Score of reduced sense of smell.
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Analysis 3.11

Comparison 3 NSAIDs versus placebo, non‐analgesic effect, Outcome 11 Score of reduced sense of smell.

Comparison 3 NSAIDs versus placebo, non‐analgesic effect, Outcome 12 Hoarseness score.
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Analysis 3.12

Comparison 3 NSAIDs versus placebo, non‐analgesic effect, Outcome 12 Hoarseness score.

Comparison 3 NSAIDs versus placebo, non‐analgesic effect, Outcome 13 Fatigue score.
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Analysis 3.13

Comparison 3 NSAIDs versus placebo, non‐analgesic effect, Outcome 13 Fatigue score.

Comparison 4 NSAIDs versus placebo, adverse effects, Outcome 1 Overall side effects (random‐effects model).
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Analysis 4.1

Comparison 4 NSAIDs versus placebo, adverse effects, Outcome 1 Overall side effects (random‐effects model).

Comparison 4 NSAIDs versus placebo, adverse effects, Outcome 2 GI complaint (fixed‐effect model).
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Analysis 4.2

Comparison 4 NSAIDs versus placebo, adverse effects, Outcome 2 GI complaint (fixed‐effect model).

Comparison 4 NSAIDs versus placebo, adverse effects, Outcome 3 Lethargy/drowsiness (fixed‐effect model).
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Analysis 4.3

Comparison 4 NSAIDs versus placebo, adverse effects, Outcome 3 Lethargy/drowsiness (fixed‐effect model).

Comparison 4 NSAIDs versus placebo, adverse effects, Outcome 4 Feeling hyperactive.
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Analysis 4.4

Comparison 4 NSAIDs versus placebo, adverse effects, Outcome 4 Feeling hyperactive.

Comparison 4 NSAIDs versus placebo, adverse effects, Outcome 5 Feeling more awake.
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Analysis 4.5

Comparison 4 NSAIDs versus placebo, adverse effects, Outcome 5 Feeling more awake.

Comparison 4 NSAIDs versus placebo, adverse effects, Outcome 6 Flushed face.
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Analysis 4.6

Comparison 4 NSAIDs versus placebo, adverse effects, Outcome 6 Flushed face.

Comparison 4 NSAIDs versus placebo, adverse effects, Outcome 7 Difficulty sleeping.
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Analysis 4.7

Comparison 4 NSAIDs versus placebo, adverse effects, Outcome 7 Difficulty sleeping.

Comparison 4 NSAIDs versus placebo, adverse effects, Outcome 8 Light‐headedness.
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Analysis 4.8

Comparison 4 NSAIDs versus placebo, adverse effects, Outcome 8 Light‐headedness.

Comparison 4 NSAIDs versus placebo, adverse effects, Outcome 9 Dry mouth.
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Analysis 4.9

Comparison 4 NSAIDs versus placebo, adverse effects, Outcome 9 Dry mouth.

Comparison 5 Head to head comparison, global effect, Outcome 1 Global improvement rating, marked improvement (fixed‐effect model).
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Analysis 5.1

Comparison 5 Head to head comparison, global effect, Outcome 1 Global improvement rating, marked improvement (fixed‐effect model).

Comparison 5 Head to head comparison, global effect, Outcome 2 Global improvement rating, moderate to marked improvement (fixed‐effect model).
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Analysis 5.2

Comparison 5 Head to head comparison, global effect, Outcome 2 Global improvement rating, moderate to marked improvement (fixed‐effect model).

Summary of findings for the main comparison. Non‐steroidal anti‐inflammatory drugs for the common cold

Non‐steroidal anti‐inflammatory drugs for the common cold

Patient or population: patients with common cold
Settings: community or care facilities or hospital
Intervention: non‐steroidal anti‐inflammatory drugs

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Non‐steroidal anti‐inflammatory drugs

Sum of overall symptom score

The mean sum of overall symptom score in the intervention groups was
0.4 standard deviations lower
(1.03 lower to 0.24 higher)

293
(3 studies)

⊕⊕⊕⊝
moderate1

Duration of colds

The mean duration of colds in the intervention groups was
0.23 lower
(0 to 0 higher)

214
(2 studies)

⊕⊕⊕⊝
moderate2

Throat irritation score

The mean throat irritation score in the intervention groups was
0.01 standard deviations lower
(0.33 lower to 0.3 higher)

159
(2 studies)

⊕⊕⊕⊝
moderate2

Headache score

The mean headache score in the intervention groups was
0.65 standard deviations lower
(1.11 to 0.19 lower)

159
(2 studies)

⊕⊕⊕⊝
moderate2

Score of pain in muscles/joints score

The mean pain in muscles/joints score in the intervention groups was
0.40 standard deviations lower
(0.77 to 0.03 lower)

0
(2 studies)

See comment

Cough score

The mean cough score in the intervention groups was
0.05 standard deviations lower
(0.66 lower to 0.56 higher)

159
(2 studies)

⊕⊕⊕⊝
moderate2

Rhinorrhoea score

The mean rhinorrhoea score in the intervention groups was
0.03 standard deviations higher
(0.25 lower to 0.3 higher)

199
(3 studies)

⊕⊕⊕⊝
moderate2

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1# NSAIDs group 141, placebo group 152.
2Too small sample size.

Figures and Tables -
Summary of findings for the main comparison. Non‐steroidal anti‐inflammatory drugs for the common cold
Comparison 1. NSAIDs versus placebo, global effect

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Sum of overall symptom score (random‐effects model) Show forest plot

3

293

Std. Mean Difference (IV, Random, 95% CI)

‐0.40 [‐1.03, 0.24]

2 Moderate to marked severity Show forest plot

1

40

Risk Ratio (M‐H, Fixed, 95% CI)

0.61 [0.18, 2.11]

3 Duration of colds (random‐effects model) Show forest plot

2

214

Mean Difference (IV, Random, 95% CI)

‐0.23 [‐1.75, 1.29]

4 Duration of restriction of daily activities Show forest plot

1

174

Mean Difference (IV, Fixed, 95% CI)

‐0.56 [‐1.24, 0.12]

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Comparison 1. NSAIDs versus placebo, global effect
Comparison 2. NSAIDs versus placebo, analgesic effect

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Throat irritation score (fixed‐effect model) Show forest plot

2

159

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.01 [‐0.33, 0.30]

2 Headache score (random‐effects model) Show forest plot

2

159

Std. Mean Difference (IV, Random, 95% CI)

‐0.65 [‐1.11, ‐0.19]

3 Score of pain in muscles/joints score (fixed‐effect model) Show forest plot

2

114

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.40 [‐0.77, ‐0.03]

4 Malaise score (fixed‐effect model) Show forest plot

2

159

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.29 [‐0.60, 0.03]

5 Chilliness score (random‐effects model) Show forest plot

2

159

Std. Mean Difference (IV, Random, 95% CI)

‐0.03 [‐1.12, 1.06]

6 Nose irritation score Show forest plot

1

80

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.04 [‐0.48, 0.40]

7 Score of pain on swallowing Show forest plot

1

80

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.07 [‐0.51, 0.37]

8 Eye itching score Show forest plot

1

80

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.14 [‐0.58, 0.30]

9 Earache score Show forest plot

1

80

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.59 [‐1.04, ‐0.14]

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Comparison 2. NSAIDs versus placebo, analgesic effect
Comparison 3. NSAIDs versus placebo, non‐analgesic effect

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Cough score (random‐effects model) Show forest plot

2

159

Std. Mean Difference (IV, Random, 95% CI)

‐0.05 [‐0.66, 0.56]

2 Sneezing score (fixed‐effect model) Show forest plot

2

159

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.44 [‐0.75, ‐0.12]

3 Total number of sneezes Show forest plot

1

80

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.51 [‐0.95, ‐0.06]

4 Rhinorrhoea score (fixed‐effect model) Show forest plot

3

199

Std. Mean Difference (IV, Fixed, 95% CI)

0.03 [‐0.25, 0.30]

5 Nasal obstruction score (fixed‐effect model) Show forest plot

3

199

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.15 [‐0.43, 0.13]

6 Nasal obstruction score > 5 Show forest plot

1

27

Risk Ratio (M‐H, Fixed, 95% CI)

5.36 [0.28, 102.12]

7 Total number of nose blows Show forest plot

1

80

Std. Mean Difference (IV, Fixed, 95% CI)

0.17 [‐0.27, 0.61]

8 Total mucus weight Show forest plot

1

40

Std. Mean Difference (IV, Fixed, 95% CI)

0.13 [‐0.49, 0.76]

9 Total tissue number count Show forest plot

1

40

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.20 [‐0.83, 0.42]

10 Score of dryness in the nose Show forest plot

1

80

Std. Mean Difference (IV, Fixed, 95% CI)

0.04 [‐0.40, 0.48]

11 Score of reduced sense of smell Show forest plot

1

80

Std. Mean Difference (IV, Fixed, 95% CI)

0.08 [‐0.36, 0.51]

12 Hoarseness score Show forest plot

1

80

Std. Mean Difference (IV, Fixed, 95% CI)

0.32 [‐0.12, 0.76]

13 Fatigue score Show forest plot

1

80

Std. Mean Difference (IV, Fixed, 95% CI)

0.18 [‐0.26, 0.62]

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Comparison 3. NSAIDs versus placebo, non‐analgesic effect
Comparison 4. NSAIDs versus placebo, adverse effects

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Overall side effects (random‐effects model) Show forest plot

2

220

Risk Ratio (M‐H, Random, 95% CI)

2.94 [0.51, 17.03]

2 GI complaint (fixed‐effect model) Show forest plot

3

189

Risk Ratio (M‐H, Fixed, 95% CI)

0.76 [0.17, 3.32]

3 Lethargy/drowsiness (fixed‐effect model) Show forest plot

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.14, 6.91]

4 Feeling hyperactive Show forest plot

1

46

Risk Ratio (M‐H, Fixed, 95% CI)

3.0 [0.13, 70.02]

5 Feeling more awake Show forest plot

1

46

Risk Ratio (M‐H, Fixed, 95% CI)

3.0 [0.13, 70.02]

6 Flushed face Show forest plot

1

46

Risk Ratio (M‐H, Fixed, 95% CI)

3.0 [0.13, 70.02]

7 Difficulty sleeping Show forest plot

1

46

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.78]

8 Light‐headedness Show forest plot

1

46

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.15, 6.51]

9 Dry mouth Show forest plot

1

46

Risk Ratio (M‐H, Fixed, 95% CI)

3.0 [0.13, 70.02]

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Comparison 4. NSAIDs versus placebo, adverse effects
Comparison 5. Head to head comparison, global effect

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Global improvement rating, marked improvement (fixed‐effect model) Show forest plot

2

365

Risk Ratio (M‐H, Fixed, 95% CI)

1.52 [0.99, 2.34]

2 Global improvement rating, moderate to marked improvement (fixed‐effect model) Show forest plot

2

365

Risk Ratio (M‐H, Fixed, 95% CI)

1.20 [1.02, 1.41]

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Comparison 5. Head to head comparison, global effect