Ann Intern Med. 2015 Jan 6;162(1):46-54. doi: 10.7326/M14-1231.
The relative efficacy of available treatments of knee osteoarthritis (OA) must be determined for rational treatment algorithms to be formulated.
To examine the efficacy of treatments of primary knee OA using a network meta-analysis design, which estimates relative effects of all treatments against each other.
MEDLINE, EMBASE, Web of Science, Google Scholar, Cochrane Central Register of Controlled Trials from inception through 15 August 2014, and unpublished data.
Randomized trials of adults with knee OA comparing 2 or more of the following: acetaminophen, diclofenac, ibuprofen, naproxen, celecoxib, intra-articular (IA) corticosteroids, IA hyaluronic acid, oral placebo, and IA placebo.
Two reviewers independently abstracted study data and assessed study quality. Standardized mean differences were calculated for pain, function, and stiffness at 3-month follow-up.
Network meta-analysis was performed using a Bayesian random-effects model; 137 studies comprising 33,243 participants were identified. For pain, all interventions significantly outperformed oral placebo, with effect sizes from 0.63 (95% credible interval [CrI], 0.39 to 0.88) for the most efficacious treatment (hyaluronic acid) to 0.18 (CrI, 0.04 to 0.33) for the least efficacious treatment (acetaminophen). For function, all interventions except IA corticosteroids were significantly superior to oral placebo. For stiffness, most of the treatments did not significantly differ from one another.
Lack of long-term data, inadequate reporting of safety data, possible publication bias, and few head-to-head comparisons.
This method allowed comparison of common treatments of knee OA according to their relative efficacy. Intra-articular treatments were superior to nonsteroidal anti-inflammatory drugs, possibly because of the integrated IA placebo effect. Small but robust differences were observed between active treatments. All treatments except acetaminophen showed clinically significant improvement from baseline pain. This information, along with the safety profiles and relative costs of included treatments, will be helpful for individualized patient care decisions.
Agency for Healthcare Research and Quality.
为了制定合理的治疗方案，必须确定治疗膝骨关节炎（OA）的现有治疗方法的相对疗效。
使用网络荟萃分析设计来检查原发性膝 OA 治疗方法的疗效，该设计估计了所有治疗方法之间的相对效果。
MEDLINE、EMBASE、Web of Science、Google Scholar、Cochrane 对照试验中心注册库（从建立到 2014 年 8 月 15 日）和未发表的数据。
比较 2 种或以上以下治疗方法的成年人随机试验：对乙酰氨基酚、双氯芬酸、布洛芬、萘普生、塞来昔布、关节内（IA）皮质类固醇、IA 透明质酸、口服安慰剂和 IA 安慰剂。
两位审阅者独立提取研究数据并评估研究质量。对于 3 个月随访时的疼痛、功能和僵硬，计算标准化均数差值。
使用贝叶斯随机效应模型进行网络荟萃分析；共确定了 137 项研究，包含 33243 名参与者。对于疼痛，所有干预措施均显著优于口服安慰剂，最有效的治疗方法（透明质酸）的效果大小为 0.63（95%可信区间[CrI]，0.39 至 0.88），最无效的治疗方法（对乙酰氨基酚）为 0.18（CrI，0.04 至 0.33）。对于功能，除 IA 皮质类固醇外，所有干预措施均显著优于口服安慰剂。对于僵硬，大多数治疗方法彼此之间没有显著差异。
缺乏长期数据、安全性数据报告不充分、可能存在发表偏倚以及缺乏头对头比较。
这种方法允许根据相对疗效比较膝骨关节炎的常见治疗方法。关节内治疗优于非甾体抗炎药，可能是因为整合了 IA 安慰剂效应。在活性治疗之间观察到微小但稳健的差异。除了对乙酰氨基酚之外，所有治疗方法均从基线疼痛开始显示出临床显著改善。这些信息，以及纳入治疗方法的安全性概况和相对成本，将有助于个体化患者护理决策。
医疗保健研究与质量局。
