The efficacy of duloxetine, non-steroidal anti-inflammatory drugs, and opioids in osteoarthritis: a systematic literature review and meta-analysis

Table 4 Indirect comparison: results for WOMAC total score change from baseline

	Duloxetine	Ibuprofen	Naproxen	Celecoxib	Etoricoxib	Tramadol	Oxycodone	Hydromorphone
Frequentist analysis
Number of studies	3	2	7^f	14^f	5	5	2	2
Change from baseline vs. placebo, mean	-6.48	-8.34	-8.27	-5.78	-11.04	-3.99	-8.56	-2.13
95% CI	[-9.09, -3.88]	[-11.98, -4.71]	[-10.27, -6.28]	[-6.86, -4.69]	[-13.24, -8.84]	[-6.74, -1.23]	[-17.23, 0.11]	[-5.99, 1.72]
I² (%)	44.35	0	51.92	32.49	0	58.03	71.99	63.54
Indirect vs. Duloxetine ^a	NA	-1.86	-1.93	0.71	-4.56	2.36	-2.07	4.35
95% CI^b	NA	[-6.33, 2.62]	[-4.70, 0.84]	[-2.12, 3.53]	[-7.97, -1.15]	[-1.00, 5.73]	[-11.13, 6.98]	[-0.31, 9.01]
Bayesian analysis
Number of studies contributing to each compound^c	3	2	9	16	5	5	2	2
Change from baseline vs. placebo, mean^d	-6.47	-7.85	-7.9	-6.2	-9.53	-2.89	-7.04	-2.19
95% CI	[-9.27, -3.7]	[-11.59, -4.18]	[-9.54, -6.27]	[-7.46, -5.03]	[-11.86, -7.3]	[-5.41, -0.54]	[-11.35, -2.95]	[-5.52, 1.21]
Indirect vs. Duloxetine^a	NA	-1.38	-1.43	0.27	-3.07	3.57	-0.58	4.28
95% CI^b	NA	[-6.04, 3.21]	[-4.65, 1.81]	[-2.78, 3.28]	[-6.66, 0.49]	[-0.17, 7.19]	[-5.69, 4.32]	[-0.01, 8.69]
Probability Duloxetine is Superior	NA	0.28	0.19	0.57	0.04	0.97	0.41	0.97
Number of studies contributing to each compound for adjusted for baseline WOMAC score^e	3	2	7	14	5	3	1	1
Indirect vs. Duloxetine adjusted for baseline WOMAC score^e	NA	1.85	0.24	0.83	-0.43	4.92	-4.67	8.19
95% CI^b	NA	[-2.13, 5.9]	[-2.36, 2.87]	[-1.45, 3.14]	[-3.4, 2.57]	[1.51, 8.34]	[-13.24, 4.07]	[3.84, 12.56]
Probability Duloxetine is Superior	NA	0.82	0.57	0.76	0.38	1	0.15	1

^aA positive (negative) result indicates that the compared treatment is worse (better) than duloxetine.
^bIf zero does not fall between the upper and lower bounds the null hypothesis (treatments are the same) is rejected.
^cThere are fewer studies in the adjusted analyses.
^dRandom effects model.
^eRandom effects model adjusting for baseline excluding trials with no baseline.
^f2 studies without placebo arms were not included in the frequentist analysis.

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