Clinical Review Extracts from “Clinical Evidence”

Non-steroidal anti-inflammatory drugs

BMJ 2000; 320 doi: (Published 15 April 2000) Cite this as: BMJ 2000;320:1058
  1. Peter C Gøtzsche, director (
  1. Nordic Cochrane Centre, Rigshospitalet, 9 Blegdamsvej, DK 2100 Copenhagen Ø, Denmark


    Definition Non-steroidal anti-inflammatory drugs (NSAIDs) have anti-inflammatory, analgesic, and antipyretic effects and inhibit thrombocyte aggregation. The drugs have no documented effect on the disease process itself.

    Incidence/prevalence NSAIDs are widely used. Almost 10% of people in the Netherlands had used a non-aspirin NSAID in 1987; the overall use was 11 defined daily doses (see box) per 1000 persons a day.1 In Australia in 1994, overall use was 35 defined daily doses per 1000 persons a day, with 36% of the people receiving NSAIDs for osteoarthritis, 42% for sprain and strain or low back pain, and 4% for rheumatoid arthritis; 35% were aged over 60 years.2

    Aims To reduce symptoms in rheumatic disorders; to avoid severe gastrointestinal adverse effects.

    Outcomes Primary outcomes: pain intensity, person's preference for one drug over another, global efficacy, and clinically significant gastrointestinal complications. Secondary outcomes: number of tender joints, perforation, gastrointestinal haemorrhage, dyspepsia, and ulcer detected by routine endoscopy.

    Defined daily dose: The assumed average daily dose for the main indication of a specified drug. The defined daily dose per 1000 population per day is an estimate of the proportion of that population receiving treatment with that drug.


    We searched Medline and the Cochrane Library in July 1999 for systematic reviews and randomised controlled trials (RCTs) that included at least 100 people. More than 100 meta-analyses and thousands of RCTs have compared various NSAIDs. Many trials are unpublished or published in sources that are not indexed in publicly available databases. The quality of the trials is variable and bias is common, both in the design and analysis of the trials, to such an extent that a systematic review identified false significant findings favouring new drugs over control drugs in 6% of trials.3



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