膝关节骨关节炎关节内注射透明质酸后治疗轨迹的meta 分析。
Therapeutic trajectory following intra-articular hyaluronic acid injection in knee osteoarthritis--meta-analysis.
机构信息
Tufts Medical Center, Boston, MA, USA.
出版信息
Osteoarthritis Cartilage. 2011 Jun;19(6):611-9. doi: 10.1016/j.joca.2010.09.014. Epub 2011 Apr 9.
OBJECTIVE
To evaluate the therapeutic trajectory of intra-articular hyaluronic acid (IAHA) vs placebo for knee osteoarthritis (OA).
DESIGN
Our data sources include Medline, EMBASE, CINAHL, BIOSIS, Web of Science, Google Scholar, Cochrane database; hand searched reviews, manuscripts, and, supplements; author contacts for unpublished data. Randomized trials that reported effects of IAHA vs placebo on knee OA were selected based on inclusion criteria. We computed effect sizes for change from baseline at 4, 8, 12, 16, 20 and 24 weeks, using Bayesian random effects model. We performed multivariate analyses adjusting for correlation between time points. Meta-regressions were performed adjusting for potential confounders.
RESULTS
The 54 eligible trials included 7545 participants. The conduct and quality of these trials varied in number of aspects. The effect size (ES) favored IAHA by week 4 (0.31; 95% CI 0.17, 0.45), reaching peak at week 8 (0.46; 0.28, 0.65), and then trending downwards, with a residual detectable effect at week 24 (0.21; 0.10, 0.31). This therapeutic trajectory was consistent among the subset of high quality trials and on multivariate analysis adjusting for correlation between time points.
CONCLUSIONS
Our meta-analysis highlights a therapeutic trajectory of IAHA for knee OA pain over 6 months post-intervention. With this additional perspective, we are able to infer that IAHA is efficacious by 4 weeks, reaches its peak effectiveness at 8 weeks and exerts a residual detectable at 24 weeks. On the other hand, the peak effect size (0.46; 0.28, 0.65), is greater than published effects from other OA analgesics [acetaminophen (ES=0.13; 0.04, 0.22); NSAIDs (ES=0.29; 0.22, 0.35); COX-2 inhibitors (ES=0.44; 0.33, 0.55)]. An effect size above 0.20 is considered to be clinically relevant on an individual patient basis in chronic pain conditions such as knee OA. Thus, its properties could have utility for certain clinical situations, or in combination with other therapies.
目的
评估关节内透明质酸（IAHA）与安慰剂治疗膝关节骨关节炎（OA）的疗效轨迹。
设计
我们的数据来源包括 Medline、EMBASE、CINAHL、BIOSIS、Web of Science、Google Scholar、Cochrane 数据库；手检综述、手稿和补充资料；作者联系未发表的数据。根据纳入标准，选择报告 IAHA 与安慰剂对膝骨关节炎影响的随机试验。我们使用贝叶斯随机效应模型计算了从基线开始 4、8、12、16、20 和 24 周的变化的效应大小。我们进行了多元分析，以调整时间点之间的相关性。进行了荟萃回归分析，以调整潜在的混杂因素。
结果
54 项合格试验纳入了 7545 名参与者。这些试验的实施和质量在许多方面存在差异。在第 4 周（0.31；95%CI 0.17，0.45），第 8 周（0.46；0.28，0.65）达到峰值，随后逐渐下降，在第 24 周仍有可检测到的残留效应（0.21；0.10，0.31）。在高质量试验亚组和调整时间点之间相关性的多元分析中，均观察到这种治疗轨迹。
结论
我们的荟萃分析强调了关节内透明质酸治疗膝关节 OA 疼痛的治疗轨迹，在干预后 6 个月内。通过这种额外的视角，我们能够推断出 IAHA 在 4 周内有效，在 8 周内达到其最佳效果，并在 24 周内仍有可检测到的效果。另一方面，最大效应量（0.46；0.28，0.65）大于其他 OA 镇痛药的已发表效应[对乙酰氨基酚（ES=0.13；0.04，0.22）；非甾体抗炎药（ES=0.29；0.22，0.35）；COX-2 抑制剂（ES=0.44；0.33，0.55）]。在慢性疼痛疾病（如膝骨关节炎）中，个体患者的效应量大于 0.20 被认为具有临床相关性。因此，它的特性在某些临床情况下或与其他治疗方法联合使用时可能具有实用性。
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