Different dosing regimens for chronic knee osteoarthritis (KOA) pain management: A pooled analysis on celecoxib

TL;DR

This study compares two dosing methods of celecoxib for knee osteoarthritis pain and finds that a once-daily dose is more effective for severe pain in the long term.

Contribution

The study provides new evidence on the long-term effectiveness of different celecoxib dosing regimens for severe knee osteoarthritis pain.

Findings

Both dosing regimens reduced pain compared to placebo in moderate and severe pain groups at week 2.

At week 6, only the 200 mg once-daily regimen remained significantly effective in severe pain patients.

WOMAC pain scores supported the VAS findings, showing greater improvement with the once-daily regimen.

Abstract

Celecoxib is widely used for the management of different chronic musculoskeletal conditions including osteoarthritis (OA), but the comparative effectiveness of 200 mg once daily (OD) versus 100 mg twice daily (BID) in patients with varying baseline pain severity is not fully established.

To compare the efficacy of celecoxib 200 mg OD and 100 mg BID in reducing pain among OA patients with moderate or severe baseline pain, using pooled post hoc analyses of two similar randomized controlled trials.

Data from two 6-week, double-blind, placebo-controlled trials in knee OA (n = 1,360) were pooled. Patients were stratified into moderate (VAS 40–69 mm, n = 675) or severe (VAS ≥ 70 mm, n = 685) pain subgroups. Interventions included celecoxib 100 mg BID, celecoxib 200 mg OD, or placebo. Primary endpoint was change from baseline in VAS pain at weeks 2 and 6, analyzed via mixed-effects model for repeated measures (MMRM) and ANCOVA with last observation carried forward. WOMAC pain score was a secondary endpoint.

Both celecoxib regimens significantly reduced VAS pain scores versus placebo at weeks 2 and 6 in the overall and moderate pain groups (p < 0.05). In severe pain patients, both regimens were superior to placebo at week 2; however, at week 6, only the 200 mg OD regimen retained statistical significance (LS mean difference vs. placebo − 7.45, p = 0.0135), while 100 mg BID did not. WOMAC pain score results mirrored VAS findings, with 200 mg OD showing the greatest improvement in severe baseline pain.

Celecoxib 100 mg BID and 200 mg OD are both effective for OA pain relief, in moderate and severe pain. Findings suggest 200 mg OD may confer an advantage in patients with severe baseline pain in the long-term treatment (week 6).

The online version contains supplementary material available at 10.1007/s40520-025-03302-2.

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