Knee osteoarthritis: 31 medications provide only uncertain pain control in large meta-analysis

  • Gregori D & al.
  • JAMA
  • 25 Dec 2018

  • curated by Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • A meta-analysis finds that long-term (≥12 months) pain control associated with 31 pharmacotherapies is uncertain (vs placebo) for patients with knee osteoarthritis (KOA).
  • The best performer, glucosamine sulfate, only improved pain by 4.10 on a scale of 1-100.

Why this matters

  • Long-term disease management of KOA is still unclear.
  • Larger randomized controlled trials (RCTs) are needed.

Study design

  • Meta-analysis of 47 RCTs (n=22,037) of medications in these categories: analgesics, antioxidants, bone-acting agents (e.g., bisphosphonates), NSAIDs, intra-articular injections, symptomatic slow-acting drugs, and putative disease-modifying agents.
  • Primary outcome was change in knee pain from baseline (most often measured by the pain scale of the Western Ontario and McMaster Universities Osteoarthritis Index) and estimated by standardized mean differences (SMDs).
  • Funding: University of Padova; Rottapharm Biotech.

Key results

  • There was large uncertainty for all estimates compared with placebo, including those with the only significant SMDs: celecoxib (SMD, −0.18; 95% credibility interval [CrI], −0.35 to −0.01) and glucosamine sulfate (SMD, −0.29; 95% CrI, −0.49 to −0.09).
  • Glucosamine sulfate remained significant when uncertainty was reduced by excluding trials with high risk for bias and when the mean pain difference was normalized on a scale from 0-100 (mean difference, −4.10; 95% CrI, −7.14 to −1.12).

Limitations

  • 100 patients per group.

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