Single dose oral celecoxib in postoperative pain

Clinical bottom line

Celecoxib is an effective treatment for acute postoperative pain. The NNT for at least 50% pain relief over four to six hours with celecoxib 200 mg was 3.5 (2.9 to 4.4) and 2.1 (1.8 to 2.5) with celecoxib 400 mg.

Reference

Updated review prepared summer 2007, with planned publication 2008

Systematic review

Date update completed: October 2007
Number of trials included: 7
Number of patients: 699 celecoxib/404 placebo
Control group: placebo
Main outcomes: pain relief at 6 hours (TOTPAR), Number-needed-to-treat (NNT) (with 95% confidence intervals) and relative benefit (with 95% confidence intervals). Duration of analgesia through time to remedication.

Inclusion criteria were single oral dose, randomised, placebo-controlled, double-blind trials of celecoxib in acute postoperative pain with sufficient data to calculate the area under the curve for pain relief (TOTPAR). Baseline pain was moderate to severe. The 6 hour TOTPAR was calculated for each patient, and the data were converted to the percent of maximum total pain relief from categorical pain scales (%maxTOTPAR), and then to dichotomous information to generate a number-needed-to-treat for at least 50% pain relief. Relative benefit was calculated to provide an assessment of how much more likely an individual given a particular treatment is to have at least 50% pain relief than someone given no treatment. Adverse effects frequency data were used to calculate numbers-needed-to-harm and relative risk.

Findings

Information from 805 patients in five trials was available for 200 mg celecoxib, and 298 patients in two trials for 400 mg. Results for 200 mg and 400 mg are given in Table 1, with limited evidence for a useful dose-response.

Table 1: NNT for celecoxib in acute pain compared with placebo

	Number of		Percent with at least 50% pain relief
Dose (mg)	Trials	Patients	Celecoxib	Placebo	Relative benefit (95% CI)	NNT (95% CI)
200	5	805	40	12	3.6 (2.6 to 5.2)	3.5 (2.9 to 4.4)
400	2	298	52	4	13 (4.7 to 37	2.1 (1.8 to 2.5)

Comment

There are no surprises with this data set. It emphasises that there appears to be a good dose response between 200 mg and 400 mg celecoxib, though in part this appears to be emphasised by low placebo response rates in both the trials involving 400 mg, thus serving to emphasise a good response with this dose.