Efficacy, tolerability, and upper gastrointestinal safety of celecoxib for treatment of osteoarthritis and rheumatoid arthritis: systematic review of randomised controlled trials
Phil Alderson, Associate Director of the UK Cochrane Centre,
immediately spotted a problem in our rapid response [1]. We stated in the
next to last paragraph that “the best available evidence to date (…)
shows, that in the long term celecoxib is no better than diclofenac in
avoiding severe gastrointestinal complications (RR for ulcer complications
1.10 [95% CI 0.47 to 2.58]).” Naturally, we agree with Phil Alderson that
the estimate accompanied by its wide confidence intervals do not provide
evidence that celecoxib is no more beneficial than diclofenac: “absence of
evidence is not evidence of absence” [2]. In fact, the relative risk’s
wide confidence intervals are compatible with celecoxib being either
considerably better or much worse than diclofenac. Therefore, we would
like to amend our statement to “there is no evidence suggesting that in
the long term celecoxib is more beneficial than diclofenac in avoiding
severe gastrointestinal complications.”
Peter Jüni MD, Senior Research Fellow in Clinical Epidemiology
Departments of Rheumatology, and Social and Preventive Medicine,
University of Berne, 3010 Berne, Switzerland (juni@ispm.unibe.ch)
Rebekka Sterchi, Research Associate
Departments of Rheumatology and Social and Preventive Medicine, University
of Berne, 3010 Berne, Switzerland
Paul Dieppe MD, Professor of Health Services Research
MRC Health Services Research Collaboration, Department of Social Medicine,
University of Bristol, Bristol BS8 2PR
Rapid Response:
Absence of evidence versus evidence of absence
Phil Alderson, Associate Director of the UK Cochrane Centre,
immediately spotted a problem in our rapid response [1]. We stated in the
next to last paragraph that “the best available evidence to date (…)
shows, that in the long term celecoxib is no better than diclofenac in
avoiding severe gastrointestinal complications (RR for ulcer complications
1.10 [95% CI 0.47 to 2.58]).” Naturally, we agree with Phil Alderson that
the estimate accompanied by its wide confidence intervals do not provide
evidence that celecoxib is no more beneficial than diclofenac: “absence of
evidence is not evidence of absence” [2]. In fact, the relative risk’s
wide confidence intervals are compatible with celecoxib being either
considerably better or much worse than diclofenac. Therefore, we would
like to amend our statement to “there is no evidence suggesting that in
the long term celecoxib is more beneficial than diclofenac in avoiding
severe gastrointestinal complications.”
Peter Jüni MD, Senior Research Fellow in Clinical Epidemiology
Departments of Rheumatology, and Social and Preventive Medicine,
University of Berne, 3010 Berne, Switzerland (juni@ispm.unibe.ch)
Rebekka Sterchi, Research Associate
Departments of Rheumatology and Social and Preventive Medicine, University
of Berne, 3010 Berne, Switzerland
Paul Dieppe MD, Professor of Health Services Research
MRC Health Services Research Collaboration, Department of Social Medicine,
University of Bristol, Bristol BS8 2PR
Reference List
1. Jüni P, Sterchi R, Dieppe PA. Problems compromising the review's
validity. bmj.com 2002: http://bmj.com/cgi/eletters/325/7365/619#26567
(accessed 20 October 2002).
2. Altman DG, Bland JM. Absence of evidence is not evidence of
absence. BMJ 1995;311:485.
Competing interests:
None declared
Competing interests: No competing interests