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比较氨基葡萄糖、硫酸软骨素、对乙酰氨基酚和塞来昔布治疗膝和/或髋骨关节炎的疗效:网状荟萃分析。

Comparative effectiveness of glucosamine, chondroitin, acetaminophen or celecoxib for the treatment of knee and/or hip osteoarthritis: a network meta-analysis.

机构信息

Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu Province, P.R. China.

Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu Province, P. R. China.

出版信息

Clin Exp Rheumatol. 2018 Jul-Aug;36(4):595-602. Epub 2018 Jan 31.


DOI:
PMID:29465368
Abstract

OBJECTIVES: To compare the efficacies of oral glucosamine, chondroitin, the combination of glucosamine and chondroitin, acetaminophen and celecoxib on the treatment of knee and/or hip osteoarthritis. METHODS: We searched electronic databases including PubMed, Embase, and Cochrane Library and the reference lists of relevant articles published from inception to October 23, 2017. A Bayesian hierarchical random effects model was used to examine the overall effect size among mixed multiple interventions. RESULTS: We identified 61 randomised controlled trials of patients with knee and/or hip osteoarthritis. There was no obvious difference in the results between the traditional meta-analysis and the network meta-analysis. The network meta-analysis demonstrated that celecoxib was most likely the best option (SMD, -0.32 [95% CI, -0.38 to -0.25]) for pain, followed by the combination of glucosamine and chondroitin. For physical function, all interventions were significantly superior to oral placebo except for acetaminophen. In terms of stiffness, glucosamine (SMD, -0.36 [95% CI, -0.67 to -0.06]) and celecoxib (SMD, -0.29 [95% CI, -0.51 to -0.08]) were significantly better compared to placebo. In view of safety, compared to placebo only, celecoxib and acetaminophen presented significant differences. CONCLUSIONS: Given the effectiveness of these non-steroidal anti-inflammatory drugs and symptomatic slow-acting drugs, oral celecoxib is more effective than placebo on relieving pain and improving physical function, followed by the combination of glucosamine and chondroitin. Acetaminophen is likely the least efficacious intervention option. This information, accompanied by the tolerability and economic costs of the included treatments, would be conducive to making decisions for clinicians.

摘要

目的:比较口服氨基葡萄糖、硫酸软骨素、氨基葡萄糖和硫酸软骨素联合、对乙酰氨基酚和塞来昔布治疗膝和/或髋骨关节炎的疗效。

方法:我们检索了电子数据库,包括 PubMed、Embase 和 Cochrane 图书馆,并检索了截至 2017 年 10 月 23 日已发表的相关文章的参考文献列表。使用贝叶斯分层随机效应模型来检验混合多种干预措施的总体效果大小。

结果:我们确定了 61 项针对膝和/或髋骨关节炎患者的随机对照试验。传统的荟萃分析和网络荟萃分析结果没有明显差异。网络荟萃分析表明,塞来昔布在疼痛方面最有可能是最佳选择(SMD,-0.32[95%CI,-0.38 至-0.25]),其次是氨基葡萄糖和硫酸软骨素联合治疗。对于身体功能,除了对乙酰氨基酚,所有干预措施与口服安慰剂相比均显著改善。在僵硬方面,与安慰剂相比,氨基葡萄糖(SMD,-0.36[95%CI,-0.67 至-0.06])和塞来昔布(SMD,-0.29[95%CI,-0.51 至-0.08])的效果更好。关于安全性,与安慰剂相比,只有塞来昔布和对乙酰氨基酚有显著差异。

结论:鉴于这些非甾体抗炎药和症状缓解慢作用药物的有效性,口服塞来昔布在缓解疼痛和改善身体功能方面比安慰剂更有效,其次是氨基葡萄糖和硫酸软骨素联合治疗。对乙酰氨基酚可能是最无效的干预措施。这些信息,以及纳入治疗的耐受性和经济成本,将有助于临床医生做出决策。

相似文献

[1]
Comparative effectiveness of glucosamine, chondroitin, acetaminophen or celecoxib for the treatment of knee and/or hip osteoarthritis: a network meta-analysis.

Clin Exp Rheumatol. 2018-1-31

[2]
Celecoxib for osteoarthritis.

Cochrane Database Syst Rev. 2017-5-22

[3]
Chondroitin for osteoarthritis.

Cochrane Database Syst Rev. 2015-1-28

[4]
Association of Pharmacological Treatments With Long-term Pain Control in Patients With Knee Osteoarthritis: A Systematic Review and Meta-analysis.

JAMA. 2018-12-25

[5]
RETRACTED: Effectiveness of non-steroidal anti-inflammatory drugs for the treatment of pain in knee and hip osteoarthritis: a network meta-analysis.

Lancet. 2016-3-18

[6]
Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis.

BMJ. 2010-9-16

[7]
Paracetamol versus placebo for knee and hip osteoarthritis.

Cochrane Database Syst Rev. 2019-2-25

[8]
Evaluation of efficacy and safety of glucosamine sulfate, chondroitin sulfate, and their combination regimen in the management of knee osteoarthritis: a systematic review and meta-analysis.

Inflammopharmacology. 2024-6

[9]
Treatment of primary and secondary osteoarthritis of the knee.

Evid Rep Technol Assess (Full Rep). 2007-9

[10]
Systemic pharmacological treatments for chronic plaque psoriasis: a network meta-analysis.

Cochrane Database Syst Rev. 2021-4-19

引用本文的文献

[1]
The Safety and Efficacy of Glucosamine and/or Chondroitin in Humans: A Systematic Review.

Nutrients. 2025-6-24

[2]
Construction and validation of a senescence-related gene signature for early prediction and treatment of osteoarthritis based on bioinformatics analysis.

Sci Rep. 2024-12-30

[3]
Comparative Efficacy of Glucosamine-Based Combination Therapies in Alleviating Knee Osteoarthritis Pain: A Systematic Review and Network Meta-Analysis.

J Clin Med. 2024-12-6

[4]
Osteoarthritis, osteoarthritis treatment and risk of incident dementia: a prospective cohort study based on UK Biobank.

Age Ageing. 2024-8-6

[5]
Triterpenes Drug Delivery Systems, a Modern Approach for Arthritis Targeted Therapy.

Pharmaceuticals (Basel). 2023-12-28

[6]
The impact of perioperative enhanced recovery nursing model on postoperative delirium and rehabilitation quality in elderly patients with femoral neck fractures.

BMC Musculoskelet Disord. 2023-12-6

[7]
Pharmatherapeutic Treatment of Osteoarthrosis-Does the Pill against Already Exist? A Narrative Review.

J Pers Med. 2023-6-30

[8]
Chondroitin sulfate and glucosamine combination in patients with knee and hip osteoarthritis: A long-term observational study in Russia.

World J Orthop. 2023-6-18

[9]
Effects of Nursing Care Using a Fast-Track Surgery Approach in 49 Patients with Early-Stage Hepatocellular Carcinoma Undergoing First-Line Treatment with Radiofrequency Ablation: A Retrospective Study.

Med Sci Monit. 2023-2-24

[10]
Osteoarthritis: pathogenic signaling pathways and therapeutic targets.

Signal Transduct Target Ther. 2023-2-3

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