Efficacy of ketoprofen vs. ibuprofen and diclofenac: a systematic review of the literature and meta-analysis

Objective The aim of this systematic review of the literature and meta-analysis of randomised controlled trials (RCTs) was to compare the efficacy of orally administered ketoprofen with that of ibuprofen and/or diclofenac. Methods The literature was systematically reviewed in accordance with the Cochrane Collaboration guidelines. The search was restricted to randomised clinical trials published in the Medline and Embase databases up to June 2011, and comparing the efficacy of oral ketoprofen (50-200 mg/day) with ibuprofen (600-1800 mg/day) or diclofenac (75-150 mg/day). Results A total of 13 RCTs involving 898 patients met the inclusion criteria: eight comparing ketoprofen with ibuprofen, and five comparing ketoprofen with diclofenac. The results of the meta-analysis showed a statistically significant difference in efficacy in favour of ketoprofen. The difference between ketoprofen and the pooled ibuprofen/diclofenac data was also statistically significant (0.459, 95% Cl 0.33-0.58; p=0.00) at all point-estimates of the mean weighted size effect. Ketoprofen was significantly superior to both diclofenac (mean = 0.422; 95% Cl 0.19-0.65, p=0.0007) and ibuprofen (mean = 0.475; 95% Cl 0.32-0.62; p=0.0000) at all point-estimates. Heterogeneity for the analysed efficacy outcome was not statisically significant in any of the meta-analyses. Conclusion The efficacy of orally administered ketoprofen in relieving moderate-severe pain and improving functional status and general condition was significantly better than that of ibuprofen and/or diclofenac.