Korean Medicine Clinical Trial Center, Korean Medicine Hospital, Kyung Hee University, (#)23 kyungheedae-ro, Dondaemun-gu, Seoul, 130-872, South Korea.
Department of Acupuncture & Moxibustion, College of Korean Medicine, Kyung Hee University, (#)23 kyungheedae-ro, Dondaemun-gu, Seoul, 130-872, South Korea.
Maturitas. 2018 Dec;118:29-37. doi: 10.1016/j.maturitas.2018.09.005. Epub 2018 Sep 30.
Aromatase inhibitor-associated arthralgia (AIA) is a common problem in breast cancer survivors and is associated with noncompliance with aromatase inhibitor therapy. The aim of this research was to assess the current evidence for the various therapeutic options available for AIA. We searched the PubMed, EMBASE, Cochrane Database of Systematic Reviews, and Database of Abstracts of Reviews of Effects for systematic reviews of trials investigating treatments for AIA to June 2018. Eligible systematic reviews were subjected to evidence mapping and the randomized controlled trials included in the systematic reviews were hand-searched for a network meta-analysis. Six systematic reviews were included in the evidence mapping. Acupuncture was the most common treatment modality studied (four randomized controlled trials), and pharmacological interventions, aerobic exercise, Nordic walking, omega-3 fatty acids, and vitamin D were assessed less frequently. In view of the limitations in the overall confidence level for each review, the evidence for acupuncture as an effective treatment for AIA was considered low. Second, data from 6 randomized controlled trials were included in the network meta-analysis. When compared with a waiting list control, acupuncture (mean difference [MD] -2.00, 95% confidence interval [CI] -3.16, -0.84), aerobic exercise (MD -0.80, 95% CI -1.33, -0.016), and omega-3 fatty acids (MD -2.10, 95% CI -3.23, -0.97) significantly improved pain severity scores. Network meta-analysis of adverse events was not possible because of poor reporting. Acupuncture is presently the most widely investigated intervention but is recommended for AIA with low overall confidence based on the current evidence.
芳香酶抑制剂相关性关节痛（AIA）是乳腺癌幸存者的常见问题，与芳香酶抑制剂治疗的不依从性有关。本研究旨在评估目前针对 AIA 可用的各种治疗选择的证据。我们检索了 PubMed、EMBASE、Cochrane 系统评价数据库和效应摘要数据库，以获取 2018 年 6 月之前调查 AIA 治疗方法的试验的系统评价。合格的系统评价进行了证据映射，系统评价中包含的随机对照试验进行了手工搜索，以进行网络荟萃分析。证据映射中包括了 6 项系统评价。针刺是研究最多的治疗方法（4 项随机对照试验），而药物干预、有氧运动、北欧式健走、ω-3 脂肪酸和维生素 D 的评估较少。鉴于每个综述的总体置信水平存在局限性，认为针刺作为 AIA 有效治疗方法的证据为低级别。其次，网络荟萃分析纳入了 6 项随机对照试验的数据。与等待名单对照组相比，针刺（平均差值 [MD] -2.00，95%置信区间 [CI] -3.16，-0.84）、有氧运动（MD -0.80，95% CI -1.33，-0.016）和 ω-3 脂肪酸（MD -2.10，95% CI -3.23，-0.97）显著改善了疼痛严重程度评分。由于报告不良，无法进行不良事件的网络荟萃分析。目前，针刺是研究最广泛的干预措施，但基于现有证据，建议对 AIA 采用总体置信度较低的方法。
