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Celecoxib para la artrosis
Livia Puljak, Ana Marin, Davorka Vrdoljak, Filipa Markotic, Ana Utrobicic, Peter Tugwell | 22 mayo 2017

Topics

Temas

Flow chart
Figuras y tablas -
Figure 1

Flow chart

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Methodological characteristics and source of funding of the included trial. (+) indicates low risk of bias, (?) unclear and (‐) a high risk of bias on a specific item.
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Figure 2

Methodological characteristics and source of funding of the included trial. (+) indicates low risk of bias, (?) unclear and (‐) a high risk of bias on a specific item.

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Forest plot of 1 trial comparing the effects of doxycycline and placebo on knee pain. Values on x‐axis denote mean differences in 50‐foot walking pain as measured on a 10‐cm VAS scale.
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Figure 3

Forest plot of 1 trial comparing the effects of doxycycline and placebo on knee pain. Values on x‐axis denote mean differences in 50‐foot walking pain as measured on a 10‐cm VAS scale.

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Forest plot of 1 trial comparing the effects of doxycycline and placebo on physical function. Values on x‐axis denote mean differences in WOMAC disability scores.
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Figure 4

Forest plot of 1 trial comparing the effects of doxycycline and placebo on physical function. Values on x‐axis denote mean differences in WOMAC disability scores.

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Forest plot of 1 trial comparing the effects of doxycycline and placebo on physical function. Values on x‐axis denote mean differences in minimum joint space width in mm.
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Figure 5

Forest plot of 1 trial comparing the effects of doxycycline and placebo on physical function. Values on x‐axis denote mean differences in minimum joint space width in mm.

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Forest plot of 1 trial comparing patients withdrawn or dropped out because of adverse events between doxycycline and placebo. Values on x‐axis denote risk ratios.
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Figure 6

Forest plot of 1 trial comparing patients withdrawn or dropped out because of adverse events between doxycycline and placebo. Values on x‐axis denote risk ratios.

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Forest plot of 1 trial comparing patients experiencing any serious adverse event between doxycycline and placebo. Values on x‐axis denote risk ratios.
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Figure 7

Forest plot of 1 trial comparing patients experiencing any serious adverse event between doxycycline and placebo. Values on x‐axis denote risk ratios.

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Comparison 1 Doxycycline versus placebo, Outcome 1 Pain.
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Analysis 1.1

Comparison 1 Doxycycline versus placebo, Outcome 1 Pain.

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Comparison 1 Doxycycline versus placebo, Outcome 2 Physical function.
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Analysis 1.2

Comparison 1 Doxycycline versus placebo, Outcome 2 Physical function.

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Comparison 1 Doxycycline versus placebo, Outcome 3 Minimum joint space width.
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Analysis 1.3

Comparison 1 Doxycycline versus placebo, Outcome 3 Minimum joint space width.

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Comparison 1 Doxycycline versus placebo, Outcome 4 Number of patients withdrawn due to adverse events.
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Analysis 1.4

Comparison 1 Doxycycline versus placebo, Outcome 4 Number of patients withdrawn due to adverse events.

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Comparison 1 Doxycycline versus placebo, Outcome 5 Number of patients experiencing any serious adverse events.
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Analysis 1.5

Comparison 1 Doxycycline versus placebo, Outcome 5 Number of patients experiencing any serious adverse events.

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Doxycycline compared with placebo for osteoarthritis of the knee or hip

Patient or population: Patients with osteoarthritis of the knee or hip

Settings: Clinical Research Centres

Intervention: Doxycycline

Comparison: Placebo

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk1

Corresponding risk

Placebo

Doxycycline

Pain

10 cm VAS scale

(follow‐up: 30 months)

2.2 cm pain
on 10 cm VAS

2.0 cm pain

(Δ ‐0.2 cm, ‐0.8 to +0.4 cm)

307
(1)

++OO
low2

Little evidence of beneficial effect (NNT: not statistically significant)

Function

WOMAC function (range 17 to 85)

(follow‐up: 30 months)

37.4 units on WOMAC
(range 17 to 85)

36.3 units on WOMAC

(Δ ‐1.1, ‐3.9 to +1.7)

307
(1)

++OO
low2

Little evidence of beneficial effect (NNT: not statistically significant)

Minimum joint space width

(follow‐up: 30 months)

‐45 mm change

‐30 mm change

(Δ 15 mm, 2 to 28 mm)

361
(1)

+++O
moderate3

No reasonable assumption could be made for the calculation of NNT

Number of patients withdrawn due to adverse events

(follow‐up: 30 months)

103 per 1000

174 per 1000
(106 to 283)

RR 1.69 (1.03 to 2.75)

431
(1)

+++O
moderate3

NNH: 14 (95% CI 6 to 324)

Number of patients experiencing any serious adverse event

(follow‐up: 30 months)

136 per 1000

141 per 1000
(88 to 227)

RR 1.04 (0.65 to 1.67)

431
(1)

++OO
low4

Little evidence of harmful effect (NNH: not statistically significant)

*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; RR: risk ratio; GRADE: GRADE Working Group grades of evidence (see explanations); NNT: number needed to treat; NNH: number needed to harm

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

1 Scores for efficacy outcomes and risks for safety outcomes from the placebo group in the trial.
2 Downgraded (2 levels) because the effect was estimated from a single trial, confidence intervals were wide and crossed no difference, and the analyses were not done according to the intention‐to‐treat principle.
3 Downgraded (1 level) because the effect was estimated from a single trial.
4 Downgraded (2 levels) because the effect was estimated from a single trial, confidence intervals were wide and crossed no difference.

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Comparison 1. Doxycycline versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain Show forest plot

1

307

Mean Difference (IV, Fixed, 95% CI)

‐0.20 [‐0.77, 0.37]

2 Physical function Show forest plot

1

307

Mean Difference (IV, Fixed, 95% CI)

‐1.10 [‐3.86, 1.66]

3 Minimum joint space width Show forest plot

1

361

Mean Difference (IV, Fixed, 95% CI)

‐0.15 [‐0.28, ‐0.02]

4 Number of patients withdrawn due to adverse events Show forest plot

1

431

Risk Ratio (IV, Fixed, 95% CI)

1.69 [1.03, 2.75]

5 Number of patients experiencing any serious adverse events Show forest plot

1

431

Risk Ratio (IV, Fixed, 95% CI)

1.04 [0.65, 1.67]
Figuras y tablas -
Comparison 1. Doxycycline versus placebo
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