Non-Cochrane · intervention · PM42143356
Systemic non-steroidal anti-inflammatory drugs as adjuncts in the treatment of chronic periodontitis: a systematic review and network meta-analysis.
Li Juan, Xie Pengxian, Peng Wei · BMC oral health · 2026 · PubMed · doi:10.1186/s12903-026-08570-6
Findings
58 findings
| Population | ||||
|---|---|---|---|---|
| Adults with chronic or aggressive periodontitis | Ibuprofen + SRP | SRP alone | Clinical attachment loss reduction 3 months | MD 1.00 [0.46, 1.54] GRADE not reported Studies not reported |
| Adults with chronic or aggressive periodontitis | Ibuprofen + SRP | SRP alone | Probing depth reduction 1 month | MD 0.58 [0.31, 0.85] GRADE not reported Studies not reported |
| Adults with chronic periodontitis (incl. aggressive periodontitis, stage III/IV grade C) | Ibuprofen + SRP | SRP | Clinical attachment level change 1 month · Not specified Unresolved: the two extractors disagree on this row. | No statistically significant differences were observed compared to SRP alone. GRADE not reported Studies not reported |
| Adults with chronic or aggressive periodontitis | Ibuprofen + SRP | SRP alone | Probing depth reduction 3 months | MD 0.56 [0.27, 0.86] GRADE not reported Studies not reported |
| Adults with chronic or aggressive periodontitis | Naproxen + SRP | SRP alone | Probing depth reduction 3 months | MD 0.35 [-0.33, 1.03] GRADE not reported Studies not reported |
| Adults with chronic or aggressive periodontitis | Naproxen + SRP | SRP alone | Probing depth reduction 1 month | MD 0.44 [0.06, 0.82] GRADE not reported Studies not reported |
| Adults with chronic or aggressive periodontitis | Ibuprofen + doxycycline + SRP | SRP alone | Clinical attachment loss reduction 3 months | MD 1.70 [1.16, 2.24] GRADE not reported Studies not reported |
| Adults with chronic or aggressive periodontitis | Ibuprofen + doxycycline + SRP | SRP alone | Probing depth reduction 3 months | MD 0.63 [0.15, 1.11] GRADE not reported Studies not reported |
| Adults with chronic or aggressive periodontitis | PUFAs + aspirin + SRP | SRP alone | Probing depth reduction 3 months | MD 0.82 [0.57, 1.07] GRADE not reported Studies not reported |
| Adults with chronic or aggressive periodontitis | PUFAs + aspirin + SRP | SRP alone | Clinical attachment loss reduction 3 months | MD 0.72 [0.39, 1.05] GRADE not reported Studies not reported |
| Adults with chronic or aggressive periodontitis | Diclofenac sodium + SRP | SRP alone | Probing depth reduction 3 months | MD 0.33 [-0.18, 0.84] GRADE not reported Studies not reported |
| Adults with chronic or aggressive periodontitis | Ibuprofen + SRP | Flurbiprofen + SRP | Clinical attachment loss reduction 3 months | MD 1.08 [0.38, 1.78] GRADE not reported Studies not reported |
| Adults with chronic or aggressive periodontitis | Ibuprofen + SRP | Flurbiprofen + SRP | Probing depth reduction 1 month | MD 0.61 [0.09, 1.14] GRADE not reported Studies not reported |
| Adults with chronic or aggressive periodontitis | Ibuprofen + SRP | Flurbiprofen + SRP | Probing depth reduction 3 months | MD 0.71 [0.11, 1.31] GRADE not reported Studies not reported |
| Adults with chronic or aggressive periodontitis | Ibuprofen + SRP | Flurbiprofen alone (no SRP) | Probing depth reduction 1 month | MD 0.60 [0.09, 1.12] GRADE not reported Studies not reported |
| Adults with chronic periodontitis (incl. aggressive periodontitis, stage III/IV grade C) | Diclofenac sodium + SRP | SRP | Clinical attachment level change 1 month · Not specified Unresolved: the two extractors disagree on this row. | No statistically significant differences were observed compared to SRP alone. GRADE not reported Studies not reported |
| Adults with chronic or aggressive periodontitis | PUFAs + aspirin + SRP | Flurbiprofen + SRP | Probing depth reduction 3 months | MD 0.97 [0.39, 1.56] GRADE not reported Studies not reported |
| Adults with chronic or aggressive periodontitis | PUFAs + aspirin + SRP | Flurbiprofen + SRP | Clinical attachment loss reduction 3 months | MD 0.80 [0.25, 1.36] GRADE not reported Studies not reported |
| Adults with chronic or aggressive periodontitis | PUFAs + aspirin + SRP | Nimesulide + SRP | Probing depth reduction 3 months | MD 1.12 [0.36, 1.89] GRADE not reported Studies not reported |
| Adults with chronic or aggressive periodontitis | Ibuprofen + doxycycline + SRP | Flurbiprofen + SRP | Probing depth reduction 3 months | MD 0.78 [0.07, 1.49] GRADE not reported Studies not reported |
| Adults with chronic or aggressive periodontitis | Ibuprofen + doxycycline + SRP | Flurbiprofen + SRP | Clinical attachment loss reduction 3 months | MD 1.78 [1.08, 2.48] GRADE not reported Studies not reported |
| Adults with chronic or aggressive periodontitis | Ibuprofen + doxycycline + SRP | Nimesulide + SRP | Probing depth reduction 3 months | MD 0.93 [0.06, 1.80] GRADE not reported Studies not reported |
| Adults with chronic or aggressive periodontitis | Ibuprofen + doxycycline + SRP | Nimesulide + SRP | Clinical attachment loss reduction 3 months | MD 1.65 [0.56, 2.74] GRADE not reported Studies not reported |
| Adults with chronic or aggressive periodontitis | Ibuprofen + SRP | Nimesulide + SRP | Probing depth reduction 3 months | MD 0.86 [0.08, 1.64] GRADE not reported Studies not reported |
| Adults with chronic periodontitis (incl. aggressive periodontitis, stage III/IV grade C) | Meloxicam + SRP | SRP | Clinical attachment level change 1 month · Not specified Unresolved: the two extractors disagree on this row. | No statistically significant differences were observed compared to SRP alone. GRADE not reported Studies not reported |
| Adults with chronic or aggressive periodontitis | Ibuprofen + doxycycline + SRP | Ibuprofen + SRP | Clinical attachment loss reduction 3 months | MD 0.70 [0.16, 1.24] GRADE not reported Studies not reported |
| Adults with chronic or aggressive periodontitis | Ibuprofen + doxycycline + SRP | PUFAs + aspirin + SRP | Clinical attachment loss reduction 3 months | MD 0.98 [0.34, 1.62] GRADE not reported Studies not reported |
| Adults with chronic or aggressive periodontitis | Ibuprofen + doxycycline + SRP | Diclofenac sodium + SRP | Clinical attachment loss reduction 3 months | MD 1.18 [0.20, 2.16] GRADE not reported Studies not reported |
| Adults with chronic or aggressive periodontitis | Ibuprofen + doxycycline + SRP | Naproxen + SRP | Clinical attachment loss reduction 3 months | MD 1.70 [0.47, 2.93] GRADE not reported Studies not reported |
| Adults with chronic or aggressive periodontitis | Any systemic NSAID regimen + SRP (all regimens pooled) | SRP alone (with or without placebo) | Probing depth reduction 1 month · Leave-one-out sensitivity: omitting Hamit Aras (2007) | SMD -1.6640329 [-3.3331575, 0.00509177] GRADE not reported 7 studies |
| Adults with chronic or aggressive periodontitis | Any systemic NSAID regimen + SRP (all regimens pooled) | SRP alone (with or without placebo) | Probing depth reduction 1 month · Leave-one-out sensitivity: omitting Veronica W-K Ng (1998) | SMD -2.09429 [-3.9128802, -0.27570015] GRADE not reported 7 studies |
| Adults with chronic or aggressive periodontitis | Any systemic NSAID regimen + SRP (all regimens pooled) | SRP alone (with or without placebo) | Probing depth reduction 3 months · Leave-one-out sensitivity: omitting Veronica W-K Ng (1998) | SMD -0.70360839 [-1.0761821, -0.33103469] GRADE not reported 7 studies |
| Adults with chronic or aggressive periodontitis | Any systemic NSAID regimen + SRP (all regimens pooled) | SRP alone (with or without placebo) | Probing depth reduction 3 months · Leave-one-out sensitivity: omitting BF Oduncuoglu (2018) | SMD -0.7904163 [-1.1878977, -0.39293486] GRADE not reported 7 studies |
| Adults with chronic or aggressive periodontitis | Any systemic NSAID regimen + SRP (all regimens pooled) | SRP alone (with or without placebo) | Clinical attachment loss reduction 3 months · Leave-one-out sensitivity: omitting Veronica W-K Ng (1998) | SMD -0.52077091 [-0.84984607, -0.19169576] GRADE not reported 6 studies |
| Adults with chronic or aggressive periodontitis | Any systemic NSAID regimen + SRP (all regimens pooled) | SRP alone (with or without placebo) | Probing depth reduction 1 month | SMD -2.12 [-4.03, -0.20] GRADE not reported 8 studies |
| Adults with chronic or aggressive periodontitis | Any systemic NSAID regimen + SRP (all regimens pooled) | SRP alone (with or without placebo) | Probing depth reduction 3 months · Leave-one-out sensitivity: all studies combined | SMD -0.74477082 [-1.0954854, -0.39405626] GRADE not reported 8 studies |
| Adults with chronic or aggressive periodontitis | Any systemic NSAID regimen + SRP (all regimens pooled) | SRP alone (with or without placebo) | Probing depth reduction 3 months · Leave-one-out sensitivity: omitting Vardar (2003) | SMD -0.77827555 [-1.1654327, -0.39111838] GRADE not reported 7 studies |
| Adults with chronic or aggressive periodontitis | Any systemic NSAID regimen + SRP (all regimens pooled) | SRP alone (with or without placebo) | Probing depth reduction 3 months | SMD -0.73 [-1.08, -0.38] GRADE not reported 8 studies |
| Adults with chronic or aggressive periodontitis | Any systemic NSAID regimen + SRP (all regimens pooled) | SRP alone (with or without placebo) | Clinical attachment loss reduction 3 months · Leave-one-out sensitivity: omitting MK Jeffcoat (1995) | SMD -0.72861195 [-1.0775536, -0.37967026] GRADE not reported 6 studies |
| Adults with chronic or aggressive periodontitis | Any systemic NSAID regimen + SRP (all regimens pooled) | SRP alone (with or without placebo) | Probing depth reduction 3 months · Leave-one-out sensitivity: omitting Elwakeel NM (2015) | SMD -0.6320895 [-0.94801003, -0.31616899] GRADE not reported 7 studies |
| Adults with chronic or aggressive periodontitis | Any systemic NSAID regimen + SRP (all regimens pooled) | SRP alone (with or without placebo) | Clinical attachment loss reduction 3 months · Leave-one-out sensitivity: omitting BF Oduncuoglu (2018) | SMD -0.6371411 [-1.0944453, -0.17983702] GRADE not reported 6 studies |
| Adults with chronic or aggressive periodontitis | Any systemic NSAID regimen + SRP (all regimens pooled) | SRP alone (with or without placebo) | Clinical attachment loss reduction 3 months · Leave-one-out sensitivity: all studies combined | SMD -0.60781834 [-0.99336022, -0.22227647] GRADE not reported 7 studies |
| Adults with chronic or aggressive periodontitis | Any systemic NSAID regimen + SRP (all regimens pooled) | SRP alone (with or without placebo) | Probing depth reduction 3 months · Leave-one-out sensitivity: omitting AM Elkhouli (2011) | SMD -0.71688187 [-1.1216822, -0.31208158] GRADE not reported 7 studies |
| Adults with chronic or aggressive periodontitis | Any systemic NSAID regimen + SRP (all regimens pooled) | SRP alone (with or without placebo) | Clinical attachment loss reduction 3 months · Leave-one-out sensitivity: omitting Vardar (2003) | SMD -0.68542427 [-1.0883594, -0.28248921] GRADE not reported 6 studies |
| Adults with chronic or aggressive periodontitis | Any systemic NSAID regimen + SRP (all regimens pooled) | SRP alone (with or without placebo) | Probing depth reduction 1 month · Leave-one-out sensitivity: omitting Heasman PA (1989) | SMD -2.4706659 [-4.3244386, -0.61689299] GRADE not reported 7 studies |
| Adults with chronic or aggressive periodontitis | Any systemic NSAID regimen + SRP (all regimens pooled) | SRP alone (with or without placebo) | Probing depth reduction 1 month · Leave-one-out sensitivity: all studies combined | SMD -2.146312 [-3.8067399, -0.48588401] GRADE not reported 8 studies |
| Adults with chronic or aggressive periodontitis | Any systemic NSAID regimen + SRP (all regimens pooled) | SRP alone (with or without placebo) | Probing depth reduction 1 month · Leave-one-out sensitivity: omitting BF Oduncuoglu (2018) | SMD -2.3699563 [-4.3602505, -0.37966239] GRADE not reported 7 studies |
| Adults with chronic or aggressive periodontitis | Any systemic NSAID regimen + SRP (all regimens pooled) | SRP alone (with or without placebo) | Clinical attachment loss reduction 3 months | SMD -0.60 [-0.97, -0.23] GRADE not reported 7 studies |
| Adults with chronic or aggressive periodontitis | Any systemic NSAID regimen + SRP (all regimens pooled) | SRP alone (with or without placebo) | Clinical attachment loss reduction 3 months · Leave-one-out sensitivity: omitting Elwakeel NM (2015) | SMD -0.58147407 [-1.0423404, -0.12060773] GRADE not reported 6 studies |
| Adults with chronic or aggressive periodontitis | Any systemic NSAID regimen + SRP (all regimens pooled) | SRP alone (with or without placebo) | Clinical attachment loss reduction 3 months · Leave-one-out sensitivity: omitting AM Elkhouli (2011) | SMD -0.58159512 [-1.0425032, -0.12068705] GRADE not reported 6 studies |
| Adults with chronic or aggressive periodontitis | Any systemic NSAID regimen + SRP (all regimens pooled) | SRP alone (with or without placebo) | Probing depth reduction 3 months · Leave-one-out sensitivity: omitting T. B. Taiyeb Ali (1993) | SMD -0.71527278 [-1.1144915, -0.31605399] GRADE not reported 7 studies |
| Adults with chronic or aggressive periodontitis | Any systemic NSAID regimen + SRP (all regimens pooled) | SRP alone (with or without placebo) | Probing depth reduction 1 month · Leave-one-out sensitivity: omitting Nurcan Buduneli (2010) | SMD -2.4551041 [-4.4010425, -0.50916564] GRADE not reported 7 studies |
| Adults with chronic or aggressive periodontitis | Any systemic NSAID regimen + SRP (all regimens pooled) | SRP alone (with or without placebo) | Probing depth reduction 1 month · Leave-one-out sensitivity: omitting T. B. Taiyeb Ali (1993) | SMD -2.3513596 [-4.33532, -0.36739886] GRADE not reported 7 studies |
| Adults with chronic or aggressive periodontitis | Any systemic NSAID regimen + SRP (all regimens pooled) | SRP alone (with or without placebo) | Probing depth reduction 1 month · Leave-one-out sensitivity: omitting Hong Zhong (2013) | SMD -1.2994556 [-2.2808237, -0.31808749] GRADE not reported 7 studies |
| Adults with chronic or aggressive periodontitis | Any systemic NSAID regimen + SRP (all regimens pooled) | SRP alone (with or without placebo) | Probing depth reduction 1 month · Leave-one-out sensitivity: omitting Xiaona Sun (2017) | SMD -2.3987377 [-4.294529, -0.50294644] GRADE not reported 7 studies |
| Adults with chronic or aggressive periodontitis | Any systemic NSAID regimen + SRP (all regimens pooled) | SRP alone (with or without placebo) | Probing depth reduction 3 months · Leave-one-out sensitivity: omitting MK Jeffcoat (1995) | SMD -0.86101341 [-1.1294923, -0.5925346] GRADE not reported 7 studies |
| Adults with chronic or aggressive periodontitis | Any systemic NSAID regimen + SRP (all regimens pooled) | SRP alone (with or without placebo) | Probing depth reduction 3 months · Leave-one-out sensitivity: omitting Hesham El-Sharkawy (2010) | SMD -0.75078565 [-1.1870656, -0.31450576] GRADE not reported 7 studies |
| Adults with chronic or aggressive periodontitis | Any systemic NSAID regimen + SRP (all regimens pooled) | SRP alone (with or without placebo) | Clinical attachment loss reduction 3 months · Leave-one-out sensitivity: omitting Hesham El-Sharkawy (2010) | SMD -0.55440557 [-1.0239089, -0.08490229] GRADE not reported 6 studies |
Included primary studies 24
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| El-Sharkawy 2010 Adjunctive treatment of chronic periodontitis with daily dietary supplementation with omega-3 Fatty acids and low-dose aspirin. PMID:20572767 | 2010 | 2 other reviews | not stated | not extracted yet |
| Elwakeel 2015 Effect of omega 3 fatty acids plus low-dose aspirin on both clinical and biochemical profiles of patients with chronic periodontitis and… PMID:25604769 | 2015 | 1 other review | not stated | not extracted yet |
| Aras 2007 Effect of Systemically Administered Naproxen Sodium on Clinical Parameters and Myeloperoxidase and Elastase‐Like Activity Levels in… DOI:10.1902/jop.2007.060412 | 2007 | this review only | not stated | not extracted yet |
| Aras 2007 Effect of systemically administered naproxen sodium on clinical parameters and myeloperoxidase and elastase-like activity levels in… PMID:17470020 | 2007 | this review only | not stated | not extracted yet |
| Buduneli 2010 Clinical findings and gingival crevicular fluid prostaglandin E2 and interleukin-1-beta levels following initial periodontal treatment and… DOI:10.1517/14656566.2010.490555 | 2010 | this review only | not stated | not extracted yet |
| Buduneli 2010 Clinical findings and gingival crevicular fluid prostaglandin E2 and interleukin-1-beta levels following initial periodontal treatment and… PMID:20518615 | 2010 | this review only | not stated | not extracted yet |
| El-Sharkawy 2010 Adjunctive Treatment of Chronic Periodontitis With Daily Dietary Supplementation With Omega‐3 Fatty Acids and Low‐Dose Aspirin DOI:10.1902/jop.2010.090628 | 2010 | this review only | not stated | not extracted yet |
| Elkhouli 2011 The efficacy of host response modulation therapy (omega-3 plus low-dose aspirin) as an adjunctive treatment of chronic periodontitis… DOI:10.1111/j.1600-0765.2010.01336.x | 2011 | this review only | not stated | not extracted yet |
| Elkhouli 2011 The efficacy of host response modulation therapy (omega-3 plus low-dose aspirin) as an adjunctive treatment of chronic periodontitis… PMID:21261621 | 2011 | this review only | not stated | not extracted yet |
| Elwakeel 2015 Effect of omega 3 fatty acids plus low‐dose aspirin on both clinical and biochemical profiles of patients with chronic periodontitis and… DOI:10.1111/jre.12257 | 2015 | this review only | not stated | not extracted yet |
| Heasman 1989 The effect of a topical non‐steroidal anti‐inflammatory drug on the development of experimental gingivitis in man DOI:10.1111/j.1600-051x.1989.tb00004.x | 1989 | this review only | not stated | not extracted yet |
| Heasman 1989 The effect of a topical non-steroidal anti-inflammatory drug on the development of experimental gingivitis in man. PMID:2760247 | 1989 | this review only | not stated | not extracted yet |
| Jeffcoat 1995 A Comparison of Topical Ketorolac, Systemic Flurbiprofen, and Placebo for the Inhibition of Bone Loss in Adult Periodontitis DOI:10.1902/jop.1995.66.5.329 | 1995 | this review only | not stated | not extracted yet |
| Jeffcoat 1995 A comparison of topical ketorolac, systemic flurbiprofen, and placebo for the inhibition of bone loss in adult periodontitis. PMID:7623251 | 1995 | this review only | not stated | not extracted yet |
| Ng 1998 Clinical Evaluation of Systemic Doxycycline and Ibuprofen Administration as an Adjunctive Treatment for Adult Periodontitis DOI:10.1902/jop.1998.69.7.772 | 1998 | this review only | not stated | not extracted yet |
| Ng 1998 Clinical evaluation of systemic doxycycline and ibuprofen administration as an adjunctive treatment for adult periodontitis. PMID:9706854 | 1998 | this review only | not stated | not extracted yet |
| Oduncuoglu 2018 Effects of a cyclic NSAID regimen on levels of gingival crevicular fluid prostaglandin E <sub>2</sub> and Interleukin-1β: A 6-month… DOI:10.4103/njcp.njcp_221_17 | 2018 | this review only | not stated | not extracted yet |
| Oduncuoglu 2018 Effects of a cyclic NSAID regimen on levels of gingival crevicular fluid prostaglandin E2and Interleukin-1β: A 6-month randomized… PMID:29735869 | 2018 | this review only | not stated | not extracted yet |
| Sun 2017 [Short-term effect of ibuprofen on clinical indexes and cytokines in the gingival crevicular fluid of patients with severe chronic… PMID:29308522 | 2017 | this review only | not stated | not extracted yet |
| Taiyeb Ali 1993 The effect of systemic ibuprofen on gingival inflammation in humans DOI:10.1111/j.1600-051x.1993.tb00697.x | 1993 | this review only | not stated | not extracted yet |
| Taiyeb Ali 1993 The effect of systemic ibuprofen on gingival inflammation in humans. PMID:8276982 | 1993 | this review only | not stated | not extracted yet |
| Vardar 2003 Effects of Selective Cyclooxygenase‐2 Inhibition on Gingival Tissue Levels of Prostaglandin E<sub>2</sub> and Prostaglandin F<sub>2α</sub>… DOI:10.1902/jop.2003.74.1.57 | 2003 | this review only | not stated | not extracted yet |
| Vardar 2003 Effects of selective cyclooxygenase-2 inhibition on gingival tissue levels of prostaglandin E2 and prostaglandin F2alpha and clinical… PMID:12593597 | 2003 | this review only | not stated | not extracted yet |
| Zhong 2013 DOI:10.14033/j.cnki.cfmr.2013.08.121 | NR | this review only | not stated | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Adults (18 years or older) with clinically diagnosed periodontitis (stage III/IV grade C, aggressive, chronic); excluded pregnancy or lactation, periodontal treatment in prior 6 months, systemic comorbidities | 549 patients with periodontitis (n=549; control n=269, experimental n=280) |
| Intervention | SRP plus single NSAID or combination of NSAIDs (systemic) | 8 regimens: ibuprofen, ibuprofen-doxycycline, flurbiprofen, naproxen, nimesulide, aspirin (with PUFAs), diclofenac sodium, meloxicam, each plus SRP (flurbiprofen also alone) (13 RCTs) |
| Comparison | Placebo; no NSAID; SRP alone | SRP alone or SRP plus placebo |
| Outcomes | PD and CAL at 1 and 3 months; adverse events | PD change at 1 month (7 interventions) and 3 months (8 interventions); CAL change at 1 month (4 interventions) and 3 months (8 interventions); adverse events not reported |
| Study designs | RCTs | 13 RCTs (n=13): 10 two-arm, 3 three-arm |
| Timing | 1-month and 3-month follow-up | 1 month and 3 months |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Partial Yes | Partial Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | NRSI: N/A · RCT: Yes | RCT: Yes · NRSI: N/A | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | NRSI: N/A · RCT: Yes | RCT: Yes · NRSI: N/A | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | No | no |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |