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Effectiveness and safety of intra-articular interventions for knee and hip osteoarthritis based on large randomized trials: A systematic review and network meta-analysis.
Pereira, Tiago V; Saadat, Pakeezah; Bobos, Pavlos; Iskander, Samir M; Bodmer, Nicolas S; Rudnicki, Martina; Dan Kiyomoto, Henry; Montezuma, Thais; Almeida, Matheus O; Bansal, Rishi; Cheng, Pai-Shan; Busse, Jason W; Sutton, Alex J; Tugwell, Peter; Hawker, Gillian A; Jüni, Peter; da Costa, Bruno R.
Afiliação
  • Pereira TV; Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK.
  • Saadat P; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
  • Bobos P; School of Physical Therapy, Western University, London, ON, Canada; Western's Bone and Joint Institute, Western University, London, ON, Canada.
  • Iskander SM; Schulich School of Medicine, University of Western Ontario, London N6A 3K7, Canada.
  • Bodmer NS; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; University of Zurich, Medical Faculty, CH-8091 Zurich, Switzerland.
  • Rudnicki M; Institute of Ophthalmology, University College London, London, UK.
  • Dan Kiyomoto H; Department of Physiotherapy, Faculty of the Americas (FAM), São Paulo, Brazil.
  • Montezuma T; Health Technology Assessment Unit, Oswaldo Cruz German Hospital, São Paulo, Brazil.
  • Almeida MO; Health Technology Assessment Unit, Oswaldo Cruz German Hospital, São Paulo, Brazil.
  • Bansal R; Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK.
  • Cheng PS; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
  • Busse JW; Department of Anesthesia, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
  • Sutton AJ; Department of Population Health Sciences, University of Leicester, Leicester, UK.
  • Tugwell P; Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
  • Hawker GA; Department of Medicine, University of Toronto, Toronto, ON, Canada.
  • Jüni P; Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto,
  • da Costa BR; Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Institute of Primary Health Care (BIHAM), University of
Osteoarthritis Cartilage ; 2024 Sep 10.
Article em En | MEDLINE | ID: mdl-39265924
ABSTRACT

OBJECTIVE:

To quantify the effectiveness and safety of intra-articular interventions for knee and hip osteoarthritis (OA) through a systematic review and Bayesian random-effects network meta-analysis.

DESIGN:

We searched CENTRAL and regulatory agency websites (inception-2023) for large, English-language, randomized controlled trials (RCTs) (≥100 patients/group) examining any intra-articular intervention. PRIMARY

OUTCOME:

pain intensity. SECONDARY

OUTCOMES:

physical function and safety outcomes. Pain and function outcomes were analyzed at 2, 6, 12, 24, and 52 weeks post-randomization, and presented as standardized mean differences (SMDs) (95% credible intervals, 95% CrI). The prespecified minimal clinically important between-group difference (MID) was -0.37 SMD. Safety outcomes were presented as odds ratios (OR) (95% CrI).

FINDINGS:

Among 57 RCTs (22,795 participants) examining 18 intra-articular interventions, usual care or placebo, treatment effects were larger in 35 high-risk-of-bias trials than in 22 low/unclear-risk-of-bias trials. In the main analysis (excluding high-risk-of-bias trials), triamcinolone had the highest probabilities of reaching the MID at weeks 2 and 6 (75.3% and 90%, respectively) with corresponding SMDs of -0.48 (95% CrI,-0.85 to -0.10) and -0.53 (95% CrI,-0.79 to -0.27) compared to placebo (1 trial). The complex homeopathic products Tr14/Ze14 showed therapeutic potential at week 6 compared to placebo (SMD-0.42, 95% CrI,-0.71 to -0.11, 63.5% probability of reaching the MID, 1 trial). Hyaluronic acid had no effect on pain (SMD-0.04, 95% CrI,-0.19 to 0.11, 11 trials) but a higher risk of dropouts due to adverse events (OR 2.01, 95% CrI,1.08 to 3.77) and serious adverse events (OR 1.86, 95% CrI, 1.16 to 3.03) than placebo.

CONCLUSION:

Triamcinolone had the highest probabilities to have a treatment effect beyond the MID at weeks 2-6. Large RCTs with lower risk of bias indicate that the effects of 16 intra-articular interventions in knee or hip OA were smaller than the MID, and that most were consistent with placebo effects. Lack of evidence of long-term effectiveness underscores the need for further research beyond 24 weeks.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Ano de publicação: 2024 Tipo de documento: Article
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Ano de publicação: 2024 Tipo de documento: Article