《疾病修饰性骨关节炎药物治疗膝骨关节炎和髋骨关节炎的疗效和安全性：系统评价和网络荟萃分析》。
The Efficacy and Safety of Disease-Modifying Osteoarthritis Drugs for Knee and Hip Osteoarthritis-a Systematic Review and Network Meta-Analysis.
机构信息
Department of Medicine, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
Department of Plastic Surgery, China-Japan Friendship Hospital, Beijing, China.
出版信息
J Gen Intern Med. 2021 Jul;36(7):2085-2093. doi: 10.1007/s11606-021-06755-z. Epub 2021 Apr 12.
BACKGROUND
Osteoarthritis (OA) is common and burdensome for patients and health care systems. Our study purpose was to evaluate the long-term efficacy and safety of DMOADs in adults with knee and hip osteoarthritis.
METHODS
We searched Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Web of Knowledge without language, publication, or date restrictions from inception through November 2018 for randomized controlled trials assessing 12 classes of DMOADs with at least 12 months of follow-up. Therapeutic effects were evaluated with pairwise and network meta-analysis. Outcomes included pain, function, minimum joint space width or cartilage volume, radiographic progression, and total joint replacement. Analyses were also performed for drug safety.
RESULTS
Twenty-eight randomized controlled trials with 11,890 patients were included. Glucosamine and chondroitin minimally improved both structure (minimum joint width or cartilage volume: network results: glucosamine: SMD 0.16; 95% CI [0.04, 0.28], chondroitin: SMD 0.21 [0.10, 0.32]) and symptoms (glucosamine: pain: - 0.15 [- 0.25, - 0.05]; function: - 0.17 [- 0.28, - 0.07], chondroitin: pain: - 0.06 [- 0.15, 0.03], and function: - 0.15 [- 0.26, - 0.03]). Strontium demonstrated improvement in structure (minimum joint width or cartilage volume: 0.20 [0.02, 0.38]), and vitamin D on symptoms (pain: - 0.15 [- 0.27, -0.03]; function: - 0.18 [- 0.31, - 0.06]). Although doxycycline also demonstrated a favorable efficacy ranking, its safety profile was poor (withdrawal: network relative risk 1.69 [1.03, 2.75]). The therapeutic effects of other medications were not ranked as highly.
DISCUSSION
Glucosamine and chondroitin yielded statistically significant but clinically questionable long-term benefit on structure and symptoms, though both had favorable safety profiles. Strontium improved structure, and vitamin D improved symptoms. Although doxycycline had a favorable efficacy ranking, its safety profile was poor. None of the 12 classes of drugs appears to have long-term clinically significant benefit.
背景
骨关节炎（OA）对患者和医疗保健系统来说是常见且负担沉重的。我们的研究目的是评估在膝和髋 OA 成人中使用 DMOAD 的长期疗效和安全性。
方法
我们在 Cochrane 对照试验中心注册库、MEDLINE、EMBASE 和 Web of Knowledge 中进行了无语言、出版或日期限制的检索，从最初到 2018 年 11 月，评估了 12 类具有至少 12 个月随访的 DMOAD 的随机对照试验。使用成对和网络荟萃分析评估治疗效果。结果包括疼痛、功能、最小关节间隙宽度或软骨体积、影像学进展和全关节置换。还对药物安全性进行了分析。
结果
纳入了 28 项随机对照试验，涉及 11890 名患者。氨基葡萄糖和软骨素对结构（最小关节间隙宽度或软骨体积：网络结果：氨基葡萄糖：SMD 0.16；95%CI [0.04，0.28]，软骨素：SMD 0.21 [0.10，0.32]）和症状（氨基葡萄糖：疼痛：-0.15 [-0.25，-0.05]；功能：-0.17 [-0.28，-0.07]，软骨素：疼痛：-0.06 [-0.15，0.03]，功能：-0.15 [-0.26，-0.03]）均有最小改善。锶在结构上有改善（最小关节间隙宽度或软骨体积：0.20 [0.02，0.38]），维生素 D 在症状上有改善（疼痛：-0.15 [-0.27，-0.03]；功能：-0.18 [-0.31，-0.06]）。虽然多西环素的疗效排名也较高，但安全性较差（停药：网络相对风险 1.69 [1.03，2.75]）。其他药物的治疗效果没有排名那么高。
讨论
氨基葡萄糖和软骨素对结构和症状有统计学上显著但临床上可疑的长期获益，尽管它们都有良好的安全性。锶改善结构，维生素 D 改善症状。虽然多西环素有较好的疗效排名，但安全性较差。12 类药物中没有一种具有长期临床显著获益。
Zotero 插件