A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS OF PHARMACOLOGICAL THERAPY IN OSTEOARTHRITIS OF THE HIP

Objective, To systematically review all randomized controlled trials ( RCT) of pharmacological therapy in osteoarthritis (OA) of the hip. To determine which nonsteroidal antiinflammatory drug (NSAID) is the most effective, and which NSAID is the most toxic. Methods, A MEDLINE sear ch was used to identify RCT of pharmacological therapy in patients wit h OA of the hip published between 1966 and August 1994. Qualitative as sessments were performed using a quality scoring system designed for N SAID trials in rheumatoid arthritis. Both the design and analysis aspe cts of the trials were evaluated, each aspect rated on a scale of 0 to 8. A quantitative method, which calculates the ratio of improvement p roduced by one NSAID to that produced by another, was used to rate the relative efficacy of different NSAID with respect to pain relief. Tox icity comparisons were made according to the authors' findings. Result s, 43 RCT were identified, and of these, 39 evaluated NSAID while 4 ev aluated only analgesics. The median design and analysis scores were 2 and 4, respectively. 6 NSAID were included in at least 5 trials; of th ese, indomethacin was rated more effective in 5 of its 7 comparisons, but more toxic in 7 of 12 comparisons. Only 5 of the 29 (17% NSAID com parisons found statistically significant differences in efficacy, Conc lusion. NSAID trials in patients with OA of the hip appear to be weake ned by the lack of standardization of case definition of OA, and also by the lack of standardization of outcome assessments. No recommendati ons for the choice of specific NSAID therapy in hip OA can be offered based on this analysis.