Foot Care Division, Department of Endocrinology and Metabolism, PGIMER, Room 0016, Nehru Extension Block, Chandigarh, 160012, India.
Diabetes and Endocrinology Department,, Tameside and Glossop Integrated Care NHS FT, Ashton under Lyne, Lancs, OL69RW, UK.
Acta Diabetol. 2021 Jun;58(6):687-696. doi: 10.1007/s00592-020-01664-9. Epub 2021 Jan 13.
No pharmacotherapeutic agents are yet recommended for active CN though many anti-resorptive agents have been studied. We conducted a systematic review and meta-analysis of the randomized placebo-controlled trials (RCTs) evaluating the time to remission of active CN with anti-resorptive or antiinflammatory drugs. RCTs published in PubMed, EMBASE, SCOPUS and Cochrane Library from January 1994 to December 2019 were accessed. We reviewed studies and extracted information on study design, participants' characteristics, time to remission, bone turnover markers, bone mineral content (BMC) and temperature difference between feet. Five RCTs out of 588 total identified records were included. Standardized mean differences (SMD) between groups with 95% CI are summarized. Pharmacotherapy nonsignificantly increased time to remission [SMD 0.52 weeks (- 0.71, 1.75), p = 0.402; I2 = 88.6%] as compared to TCC alone. The pooled median time to remission with the intervention was 18.5 weeks (11.2, 28.1) compared to 16.8 weeks (8.7, 27.7) with TCC. A nonsignificant increase in BMC [SMD 3.39% (- 0.78, 7.56), p = 0.109; I2 = 96.7%], a decrease in foot temperature [SMD - 0.42 °C (- 0.78, - 0.07), p = 0.020; I2 = 0%] and alkaline phosphatase [SMD = -2.51% (- 3.24, - 1.77), p < 0.001; I2 = 0%] was observed with intervention. Limited evidence from available studies does not support the role of anti-resorptive or anti-inflammatory drugs for earlier remission when added to offloading with total contact cast for active CN of the foot.
目前尚无药物治疗推荐用于活动性 CN，尽管已经研究了许多抗吸收药物。我们对评估抗吸收或抗炎药物治疗活动性 CN 缓解时间的随机安慰剂对照试验 (RCT) 进行了系统评价和荟萃分析。检索了 1994 年 1 月至 2019 年 12 月期间在 PubMed、EMBASE、SCOPUS 和 Cochrane Library 上发表的 RCTs。我们对研究进行了综述，并提取了研究设计、参与者特征、缓解时间、骨转换标志物、骨矿物质含量 (BMC) 和足部温差等信息。从 588 项记录中确定了 5 项 RCT 纳入研究。总结了组间标准化均数差值 (SMD) 及其 95%置信区间。与单独 TCC 相比，药物治疗对缓解时间的影响无统计学意义 [SMD 0.52 周（-0.71，1.75），p = 0.402；I2 = 88.6%]。干预组的缓解中位时间为 18.5 周（11.2，28.1），而 TCC 组为 16.8 周（8.7，27.7）。BMC 有增加的趋势[SMD 3.39%（-0.78，7.56），p = 0.109；I2 = 96.7%]，足部温度降低[SMD - 0.42°C（-0.78，-0.07），p = 0.020；I2 = 0%]，碱性磷酸酶降低[SMD = -2.51%（-3.24，-1.77），p < 0.001；I2 = 0%]。现有研究的有限证据不支持在使用全接触石膏对足部活动性 CN 进行减压治疗的基础上加用抗吸收或抗炎药物来更早缓解疾病。
