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