Edited by André Sofair, MD, MPH, and William E. Chavey, MD, MS
Diclofenac, etoricoxib, and rofecoxib were associated with the greatest pain reduction for patients with knee or hip osteoarthritis, while acetaminophen was not superior to placebo, in a network meta-analysis in the Lancet. (Etoricoxib is not available in the U.S.; rofecoxib was withdrawn worldwide in 2004.)
Researchers assessed 74 randomized, controlled trials of nearly 60,000 patients with knee or hip osteoarthritis that compared NSAIDs (rofecoxib, lumiracoxib, etoricoxib, diclofenac, celecoxib, ibuprofen, naproxen), acetaminophen, and placebo.
The following regimens appeared to be the most effective in pain reduction: diclofenac (150 mg/day), etoricoxib (60 mg/day), and rofecoxib (25 mg/day). Meanwhile, acetaminophen did not have a consistent, clinically meaningful benefit up to doses of 4000 mg per day.
Commentators write: “The most remarkable result is that [acetaminophen] does not seem to confer any demonstrable effect or benefit in osteoarthritis, at any dose. … [Acetaminophen] has been on the market for as long as most of us remember. Its efficacy has never been properly established or quantified in chronic diseases, and is probably not as great as many would believe.”