Bispebjerg and Frederiksberg Hospital, University of Copenhagen, The Parker Institute, Copenhagen, Denmark
Section for Biostatistics and Evidence-Based Research, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, The Parker Institute, Copenhagen, Denmark.
RMD Open. 2023 Aug;9(3). doi: 10.1136/rmdopen-2023-003030.
To explore the comparative effectiveness of pharmacological interventions for hand osteoarthritis (OA).
We systematically searched Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials from inception until 26 December 2021, for randomised trials of pharmacological interventions for people with hand OA. Two reviewers independently extracted study data and assessed the risk of bias. We calculated the effect sizes for pain (standardised mean differences) using Bayesian random effects models for network meta-analysis (NMA) and pairwise meta-analysis. Based on a pre-specified protocol, we prospectively registered the study at PROSPERO, CRD42021215393.
We included 72 trials with 7609 participants. 65 trials (n=5957) were eligible for the quantitative synthesis, investigating 29 pharmacological interventions. Oral non-steroidal anti-inflammatory drugs (NSAIDs) and oral glucocorticoids' NMA effect sizes were -0.18 (95% credible interval -0.36 to 0.02) and -0.54 (-0.83 to -0.24), respectively, compared with placebo, and the result was consistent when limiting evidence to the pairwise meta-analysis of trials without high risk of bias. Intra-articular hyaluronate, intra-articular glucocorticoids, hydroxychloroquine, and topical NSAIDs' NMA effect sizes were 0.22 (-0.08 to 0.51), 0.25 (0.00 to 0.51), -0.01 (-0.19 to 0.18), and -0.14 (-0.33 to 0.08), respectively, compared with placebo. Oral NSAIDs were inferior to oral glucocorticoids with an NMA effect size of 0.36 (0.01 to 0.72). No intervention was superior to placebo when stratifying for thumb and finger OA.
Oral NSAIDs and glucocorticoids are apparently effective pharmacological interventions in hand OA. Intra-articular therapies and topical NSAIDs were not superior to placebo.
探讨手部骨关节炎（OA）药物干预的疗效比较。
我们系统地检索了 Embase、MEDLINE 和 Cochrane 对照试验中心注册库，检索时间从建库至 2021 年 12 月 26 日，以获取手部 OA 患者药物干预的随机试验。两位审查员独立提取研究数据并评估偏倚风险。我们使用贝叶斯随机效应模型进行网络荟萃分析（NMA）和成对荟萃分析，计算疼痛（标准化均数差）的效应大小。根据预先制定的方案，我们在 PROSPERO 前瞻性注册了该研究（CRD42021215393）。
我们纳入了 72 项试验，共 7609 名参与者。65 项试验（n=5957）纳入定量合成，共涉及 29 种药物干预。与安慰剂相比，口服非甾体抗炎药（NSAIDs）和口服糖皮质激素的 NMA 效应量分别为-0.18（95%可信区间-0.36 至 0.02）和-0.54（-0.83 至-0.24），当将证据仅限于无高偏倚风险的试验进行成对荟萃分析时，结果是一致的。关节内透明质酸、关节内糖皮质激素、羟氯喹和局部 NSAIDs 的 NMA 效应量分别为 0.22（-0.08 至 0.51）、0.25（0.00 至 0.51）、-0.01（-0.19 至 0.18）和-0.14（-0.33 至 0.08），与安慰剂相比。与口服糖皮质激素相比，口服 NSAIDs 的 NMA 效应量为 0.36（0.01 至 0.72），效果较差。在按拇指和手指 OA 分层时，没有一种干预措施优于安慰剂。
口服 NSAIDs 和糖皮质激素对手部 OA 是有效的药物干预措施。关节内治疗和局部 NSAIDs 并不优于安慰剂。
