Comparison of the efficacy and safety of non-steroidal anti-inflammatory drugs for patients with primary dysmenorrhea: A network meta-analysis

Abstract

ObjectiveNon-steroidal anti-inflammatory drugs are used as first-line treatment of primary dysmenorrhea, but there has been no optimal clinical choice among non-steroidal anti-inflammatory drugs yet. The present study was to assess the relative benefits of different common non-steroidal anti-inflammatory drugs for primary dysmenorrhea patients with a network meta-analysis.MethodsRandomized controlled trials were screened by our criteria and included in the network meta-analysis. Pain relief was considered as primary outcomes and adverse effect was supplied as a safety outcome, while additional rescue, assessment score, and pain intensity difference were secondary outcomes. All the indexes were evaluated with odds ratio or standardized mean difference. Surface under cumulative ranking curve result was used to calculate the ranking of each treatment.ResultsTotally, 72 randomized controlled trials of 5723 patients and 13 drugs were included in our study after screening. As for pain relief, all drugs except nimesulide, rofecoxib, and waldecoxib were superior to aspirin (odds ratio with 95% credible intervals, diclofenac: 0.28 (0.08, 0.86), flurbiprofen: 0.10 (0.03, 0.29), ibuprofen: 0.32 (0.14, 0.73), indomethacin: 0.21 (0.07, 0.58), ketoprofen: 0.25 (0.10, 0.64), mefenamic acid: 0.28 (0.09, 0.87), naproxen: 0.31 (0.15, 0.64), piroxicam: 0.15 (0.03, 0.59), and tiaprofenic acid: 0.17 (0.04, 0.63)). Aspirin also required additional rescue when compared with the majority of other drugs (flurbiprofen: 3.46 (1.15, 11.25), ibuprofen: 6.30 (2.08, 20.09), mefenamic acid: 7.32 (1.51, 37.71), naproxen: 2.66 (1.17, 6.55), and tiaprofenic acid: 9.58 (1.43, 94.63)). As for assessment of the whole treatment, ketoprofen, naproxen, rofecoxib, and ibuprofen got higher score significantly than placebo. In addition, ibuprofen performed better than placebo in pain intensity difference. Considering the safety, tiaprofenic acid and mefenamic acid were noticeable in low risk, and indomethacin revealed higher risk than any other drugs. According to the results of network analysis and surface under cumulative ranking curve, flurbiprofen was considered to be the best one among all the treatments in efficacy, and aspirin was worse than most of others. On the other hand, tiaprofenic acid and mefenamic acid were indicated as the safest drugs.ConclusionConsidering the efficacy and safety, we recommended flurbiprofen and tiaprofenic acid as the optimal treatments for primary dysmenorrhea.

Phenotypic screening of nonsteroidal anti-inflammatory drugs identified mefenamic acid as a drug for the treatment of schistosomiasis

“…In addition to analgesic, anti-inflammatory and antipyretic properties, mefenamic acid has often been used for the treatment of dysmenorrhea in adolescents and adults [43,44]. As an advantage, mefenamic acid is rapidly absorbed after oral administration, has a short half-life, and it is more tolerant than other NSAIDs [35].…”

Ten‐year trend of opioid and nonopioid analgesic use in the French adult population

“…30 Their use was particularly widespread in women younger than 45 years, for whom the indication could be dysmenorrhoea. 31 In 2015, paracetamol was the most used peripheral analgesic in France, followed by ibuprofen and aspirin. The pattern of nonopioid differs from country to country in Europe.…”

Role of Col1a1 and G2046t Genes in Uzbeks With Juvenile Dysmenorrhea in the Presence of Criteria for Undifferentiated Connective Tissue Dysplasia

“…Juvenile dysmenorrhea (JD) -painful menstruation in girls under 18 in the absence of pelvic pathology is a common and often depleting gynecological suffering, regardless of age or nationality [15,19,25]. Despite the high prevalence, primary dysmenorrhea in girls is often poorly diagnosed and even ignored by medical professionals and the girls themselves and their mothers, who can accept painful menstruation as a normal part of the menstrual cycle [7,18,20].…”