Background Patients with rheumatic diseases, including rheumatoid arthritis, describe symptoms like pain and stiffness as important factors affecting their quality of life. Considering treatment options available for rheumatoid arthritis, NSAIDs, such as ketoprofen and ibuprofen, are the most widely used drugs to decrease inflammation and to manage mild-to-moderate pain. Our previous meta-analysis demonstrated a superior efficacy of ketoprofen vs ibuprofen in relieving different kind of moderate-to-severe pain conditions.

Objectives The aim of this new systematic review of the literature and meta-analysis of randomized controlled trials (RCTs) was to compare the clinical efficacy of ketoprofen and ibuprofen in patients with rheumatoid arthritis, a specific pain condition.

Methods A systematic literature search was performed on main scientific databases (Medline and Embase) from inception to March 2014 in accordance with the Cochrane Collaboration guideline in order to identify RCTs comparing directly recommended therapeutic doses of oral ketoprofen (50-200 mg/day) vs ibuprofen (600-1800 mg/day) for rheumatoid arthritis pain relief. The meta-analysis was made using the standardized mean differences (SMD) of each included RCT. A fixed effects model was adopted.

Results A total of 5 RCTs, involving 456 patients met the inclusion criteria. The result of meta-analysis showed a statistically significant difference in clinical efficacy in favour of ketoprofen vs ibuprofen (SMD=0.34; CI 95% 0.16-0.52; p=0.0002). The heterogeneity test for the efficacy outcome was not statistically significant and equal to zero (χ²=3.67 - df=4 - P=0.45 – I²=0%) demonstrating homogeneity of included trials and the validity of meta-analysis results. In addition, studies included in this meta-analysis did not reveal any significant differences between the two drugs in terms of tolerability (% of patients who developed adverse events) and safety (withdrawn patients).

• Download figure
• Open in new tab
• Download powerpoint

Conclusions The result of this meta-analysis shows that ketoprofen at therapeutic doses is more efficacious than ibuprofen in pain management of rheumatoid arthritis, supporting its use in clinical practice.

References

1. Calin A et al. Double-blind, multi-centre parallel trial of ketoprofen and ibuprofen in the treatment of rheumatoid arthritis. J Rheumatol. 1977; 4(2):153-157; 19.

2. Mills SB et al. Double-blind cross-over study of ketoprofen and ibuprofen in management of rheumatoid arthritis. Br Med J. 1973; 4(5884):82-84; 20.

3. Montrone F et al. A double-blind cross-over evaluation of ketoprofen (Orudis) and ibuprofen in the management of rheumatoid arthritis. Rheumatol Rehabil. 1979;18(2):114-118.

4. Huskisson EC et al. Four new anti-inflammatory drugs: responses and variations. Br Med J. 1976 May 1;1(6017):1048-9.

Disclosure of Interest F. Atzeni: None declared, M. Bagnasco Employee of: Dompé farmaceutici, L. Lanata Employee of: Dompé farmaceutici, P. Sarzi Puttini: None declared