塞來昔布治療類風濕性關節炎或骨關節炎療效和安全性的Meta分析_《中國循證醫學雜志》

作者：

孟敏 ¹ , 劉麗春 ¹ , 葛斌 ¹ ,  湯浩 ¹ , 吳玉瓊 ² , 徐楊 ³

1. 甘肅省人民醫院藥劑科（蘭州?730000）；2. 甘肅省第二人民醫院藥劑科（蘭州?730000）；3. 甘肅省腫瘤醫院科教科（蘭州?730000）;

關鍵詞：

塞來昔布萘普生類風濕性關節炎骨關節炎系統評價 Meta分析隨機對照試驗

DOI：

10.7507/1672-2531.20110099

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目的　系統評價塞來昔布治療類風濕性關節炎和骨關節炎的有效性和安全性。
方法　計算機檢索EMbase、PubMed、The Cochrane Library、CBM、CJFD和CSJD，搜集有關塞來昔布治療類風濕性關節炎或骨關節炎的隨機對照試驗（RCT）。由兩位研究者按照納入與排除標準篩選文獻、提取資料和評價質量后，采用RevMan 5.0軟件進行Meta分析。
結果　共納入4 個RCT，共2 931 例患者。Meta分析結果顯示：① 不同劑量的塞來昔布和500 mg bid的萘普生治療類風濕性關節炎或骨關節炎的效果差異有統計學意義；② 塞來昔布和安慰劑組的胃腸道反應差異無統計學意義［RR=1.29，95%CI（0.93，1.79）］；③ 塞來昔布和萘普生的胃腸道反應差異有統計學意義［RR=0.78，95%CI（0.64，0.95）］；④ 塞來昔布和萘普生治療類風濕性關節炎或骨關節炎的胃腸道潰瘍程度差異有統計學意義［RR=1.29，95%CI（0.93，1.79）］。ITT分析結果表明：塞來昔布和萘普生治療類風濕性關節炎或骨關節炎的胃腸道副反應程度差異有統計學意義［RR=0.84，95%CI（0.77，0.92）］。
結論　不同劑量塞來昔布治療類風濕性關節炎或骨關節炎和500 mg bid的萘普生相比，其療效相差各異，但塞來昔布的胃腸道反應與安慰劑相當，低于萘普生組。但上述結果尚需高質量的隨機對照試驗進一步驗證。

引用本文： 孟敏,劉麗春,葛斌,湯浩,吳玉瓊,徐楊. 塞來昔布治療類風濕性關節炎或骨關節炎療效和安全性的Meta分析. 中國循證醫學雜志, 2011, 11(5): 560-564. doi: 10.7507/1672-2531.20110099 復制

1.	1 Kvien TK. Epidemiology and burden of illness of rheumatoid arthritis. Pharmacoeconomics , 2004, 22(2 Suppl 1): 1-12.
2.	Nivsrkar M. Improvement in circulating superoxide dismutase levels: Role of nonsteroidal anti-inflammatory drugs in rheumatoid arthritis biochemical and biophysical. Research Communications , 2000, 270(3): 714-716.
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6.	Jadad AR, Moore RA, Carroll D, et al . Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials , 1996, 17(1): 1-12.
7.	Bensen WG, Flechtner JJ, Mcmillen JI, et al . Treatment of osteoarthritis with Celecoxib, a cyclooxygensae-2 Inhibitor: A randomized controlled trial. Mayo Clin Proc , 1999, 74(11): 1095-1105.
8.	Simon LS, Weave AL, Graham DY, et al . Anti-inflammatory and upper gastrointestinal effects of Celecoxib in rheumatoid arthritis: A randomized controlled trial. JAMA , 1999, 282(20): 1921-1928.
9.	Goldstein JL, Correa P, Zhao WW, et al . Reduced incidence of gastroduodenal ulcers with celecoxib, a novel cyclooxygenase-2 inhibitor, compared to naproxen in patients with arthritis. Am J Gastroenterol , 2001, 96(4): 1019-1027.
10.	Foeldvari I, Szer IS, Zemel LS, et al . A prospective study comparing Celecoxib with Naproxen in children with juvenile rheumatoid arthritis. The Journal of Rheumatology , 2009, 36(1): 174-182.
11.	Zhao SZ, Mcmillen JI, Markenson JA, et al . Evaluation of the functional status aspects of Health-Related Quality of Life of patients with osteoarthritis treated with Celecoxib. Pharmacotherapy , 1999, 19(11): 1269-1278.
12.	Zhao SZ, Fiechtner JJ, Tindall EA, et al . Evaluation of Health-Related Quality of Life of rheumatoid arthritis patients treated with Celecoxib. Arthritis Care and Research , 2000, 13(2): 112-121.
13.	Becker MC, Wang TH, Wisniewski L, et al . Rationale, design, and governance of prospective randomized evaluation of Celecoxib integrated safety versus Ibuprofen or Naproxen (PRECISION), a cardiovascular end point trial of nonsteroidal anti-inflammatory agents in patients with arthritis. Am Heart J , 2009, 157(4): 606-612.
14.	Bensen WG, Fiechtner JJ, Mcmillen JI, 等. 塞來昔布治療骨關節炎的隨機對照試驗. 中國新藥雜志, 2000, 9(8): 569-574.
15.	Solomon SD, Wittes J, Finn PV, et al . Cardiovascular risk of Celecoxib in 6 randomized placebo-controlled trials: the cross trial safety analysis. Circulatio , 2008, 117(16): 2104-2113.
16.	Lelorier J, Fitzsimon C, Keresteci M, et al . Drug utilization review of Celecoxib in Ontario. Rheumatology , 2003, 42(suppl 3): 11-16.
17.	徐慧敏, 徐翔. 綜合性醫院門診患者塞來昔布（西樂葆）使用的處方分析. 中國藥學雜志, 2009, 44(20): 1596-1598.

1. 1 Kvien TK. Epidemiology and burden of illness of rheumatoid arthritis. Pharmacoeconomics , 2004, 22(2 Suppl 1): 1-12.
2. Nivsrkar M. Improvement in circulating superoxide dismutase levels: Role of nonsteroidal anti-inflammatory drugs in rheumatoid arthritis biochemical and biophysical. Research Communications , 2000, 270(3): 714-716.
3. 畢會民, 胡勝, 甘佩珍, 等. 塞來考昔對女性卵巢功能的影響. 中國新藥與臨床, 2004, 23(8): 538-539.
4. Niederberger E, Manderscheid C, Grösch S, et al . Effects of the selective COX-2 inhibitors celecoxib and rofecoxib on human vascular cells. Biochem Pharmacol , 2004, 68(2): 341-350.
5. Laine L, Connor LG, Reicin A, et al . Serious lower gastrointestinal clinical events with nonselective NSAID or Coxib Use. Gastroenterology , 2003, 124(2): 288-292.
6. Jadad AR, Moore RA, Carroll D, et al . Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials , 1996, 17(1): 1-12.
7. Bensen WG, Flechtner JJ, Mcmillen JI, et al . Treatment of osteoarthritis with Celecoxib, a cyclooxygensae-2 Inhibitor: A randomized controlled trial. Mayo Clin Proc , 1999, 74(11): 1095-1105.
8. Simon LS, Weave AL, Graham DY, et al . Anti-inflammatory and upper gastrointestinal effects of Celecoxib in rheumatoid arthritis: A randomized controlled trial. JAMA , 1999, 282(20): 1921-1928.
9. Goldstein JL, Correa P, Zhao WW, et al . Reduced incidence of gastroduodenal ulcers with celecoxib, a novel cyclooxygenase-2 inhibitor, compared to naproxen in patients with arthritis. Am J Gastroenterol , 2001, 96(4): 1019-1027.
10. Foeldvari I, Szer IS, Zemel LS, et al . A prospective study comparing Celecoxib with Naproxen in children with juvenile rheumatoid arthritis. The Journal of Rheumatology , 2009, 36(1): 174-182.
11. Zhao SZ, Mcmillen JI, Markenson JA, et al . Evaluation of the functional status aspects of Health-Related Quality of Life of patients with osteoarthritis treated with Celecoxib. Pharmacotherapy , 1999, 19(11): 1269-1278.
12. Zhao SZ, Fiechtner JJ, Tindall EA, et al . Evaluation of Health-Related Quality of Life of rheumatoid arthritis patients treated with Celecoxib. Arthritis Care and Research , 2000, 13(2): 112-121.
13. Becker MC, Wang TH, Wisniewski L, et al . Rationale, design, and governance of prospective randomized evaluation of Celecoxib integrated safety versus Ibuprofen or Naproxen (PRECISION), a cardiovascular end point trial of nonsteroidal anti-inflammatory agents in patients with arthritis. Am Heart J , 2009, 157(4): 606-612.
14. Bensen WG, Fiechtner JJ, Mcmillen JI, 等. 塞來昔布治療骨關節炎的隨機對照試驗. 中國新藥雜志, 2000, 9(8): 569-574.
15. Solomon SD, Wittes J, Finn PV, et al . Cardiovascular risk of Celecoxib in 6 randomized placebo-controlled trials: the cross trial safety analysis. Circulatio , 2008, 117(16): 2104-2113.
16. Lelorier J, Fitzsimon C, Keresteci M, et al . Drug utilization review of Celecoxib in Ontario. Rheumatology , 2003, 42(suppl 3): 11-16.
17. 徐慧敏, 徐翔. 綜合性醫院門診患者塞來昔布（西樂葆）使用的處方分析. 中國藥學雜志, 2009, 44(20): 1596-1598.

《中國循證醫學雜志》

塞來昔布治療類風濕性關節炎或骨關節炎療效和安全性的Meta分析

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《中國循證醫學雜志》

塞來昔布治療類風濕性關節炎或骨關節炎療效和安全性的Meta分析

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