Knee and Hip Osteoarthritis: Efficacy and Safety of Disease-Modifying Drugs

Takeaway

• In patients with knee and hip osteoarthritis (OA), glucosamine and chondroitin demonstrated marginal small yet significant structural and symptomatic effects, in addition to favourable safety.
• Strontium showed therapeutic benefit in terms of structure modification and vitamin D improved symptoms.
• Doxycycline demonstrated a promising efficacy ranking, but has a poor safety profile.

Why this matters

• Findings could help physicians, patients, and researchers in making informed decisions regarding the use of disease-modifying OA drugs (DMOADs) in treatment, clinical studies, and basic research into OA.

Study design

• UK researchers performed a network meta-analysis of 28 randomised controlled trials (n=11,890) assessing 12 classes of DMOADs with ≤12 months of follow-up.
• Funding: None disclosed.

Key results

• Glucosamine and chondroitin marginally improved (standardised mean difference [SMD]; 95% CI:
  • minimum joint width or cartilage volume:
    • glucosamine (0.16; 0.04-0.28); and
    • chondroitin (0.21; 0.10-0.32).
  • pain:
    • glucosamine (-0.15; -0.25 to -0.05;); and
    • chondroitin (-0.06; -0.15 to 0.03).
  • function:
    • glucosamine (-0.17; -0.28 to -0.07); and
    • chondroitin (-0.15; -0.26 to -0.03;).
• Strontium was associated with an improvement in minimum joint width or cartilage volume (SMD, 0.20; 95% CI, 0.02-0.38).
• Vitamin D showed improvement in:
  • pain (SMD, -0.15; 95% CI, -0.27 to -0.03); and
  • function (SMD, -0.18; 95% CI, -0.31 to -0.06;).
• Doxycycline demonstrated favourable efficacy in terms of structure and function, but its safety profile was poor (withdrawal because of adverse events: relative risk, 1.69; 95% CI, 1.03-2.75).

Limitations

• None of the individual trials provided outcome data stratified by OA stage.

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.