SYSTEMATIC REVIEW article
Front. Pharmacol.
Sec. Inflammation Pharmacology
Comparative Efficacy and Safety of Imrecoxib versus Celecoxib: A Systematic Review and Meta-Analysis
Provisionally accepted
- 1药剂科, The Affiliated Hospital of Guilin Medical University, Guilin, China
- 2桂林理工大学公共管理学院, 桂林市, China
- 3桂林医科大学, 桂林市, China
- 4新生儿科, The Affiliated Hospital of Guilin Medical University, Guilin, China
- 5The Affiliated Hospital of Guilin Medical University, Guilin, China
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Objective: This meta-analysis aimed to compare the analgesic efficacy, anti-inflammatory effects, and safety profiles of the selective cyclooxygenase-2 (COX-2) inhibitors imrecoxib (IMR) and celecoxib (CEL), providing evidence-based guidance for clinical drug selection. Methods: A systematic search was conducted of English and Chinese databases through August 2025 to identify randomized controlled trials (RCTs) comparing IMR and CEL. Methodological quality was assessed using the Cochrane Risk of Bias (ROB 2.0) tool, and quantitative analyses were performed using R software. Primary outcomes included clinical response rate, pain intensity assessed by the visual analog scale (VAS), and the overall incidence of adverse events (AEs). Secondary outcomes focused on serum inflammatory markers (CRP and ESR) and disease activity (BASDAI) in patients with axial spondyloarthritis (axSpA). Results: Pooled analyses found no significant differences between IMR and CEL in clinical response or pain reduction, indicating comparable analgesic efficacy. The overall safety profiles of the two drugs were also similar. Notably, in the osteoarthritis (OA) subgroup, IMR was associated with a significantly lower incidence of adverse events compared with CEL. An exploratory subgroup analysis in axSpA patients suggested that IMR may offer potential advantages over CEL in improving inflammatory markers and disease activity. However, this finding is based on a few small trials and should be interpreted with caution due to the low certainty of evidence. Conclusion: IMR demonstrated comparable efficacy and overall safety to CEL, supporting its role as a viable alternative selective COX-2 inhibitor in clinical practice.IMR may have potentially favorable anti-inflammatory effects in axSpA. The observed anti-inflammatory advantage of IMR in axSpA remains to be confirmed. Given the limitations of small sample sizes, short follow-up durations, and incomplete safety reporting, further large-scale, high-quality RCTs are warranted to validate these findings.
Keywords: Imrecoxib, Celecoxib, cox-2 inhibitors, Meta-analysis, analgesic, Safety
Received: 17 Sep 2025; Accepted: 26 Nov 2025.
Copyright: © 2025 Zeng, Dai, Li, Dong, Liao, Chen, Tan and CHEN. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Yuan Tan
Wei CHEN
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