Tuesday, 19 Mar 2019

You are here

Uncertain Long Term Efficacy in Trials of Knee Osteoarthritis

A systematic review and network meta-analysis of 47 randomized clinical trials in knee osteoarthritis finds uncertainty around estimates of effect size for pain scores thereby casting uncertainty over the long-term efficacy of medications for knee osteoarthritis.

JAMA reports a network meta-analysis of 47 RCTs (lasting from 1-4 years), involving 22 037 patients; mostly 55-70 years, with knee osteoarthritis who are randomized to receive analgesics; antioxidants; bone-acting agents (e.g., bisphosphonates) nonsteroidal anti-inflammatory drugs (NSAIDS); intra-articular injections (hyaluronic acid or corticosteroids), glucosamine and chondroitin sulfate; and newer agents such as cindunistat and sprifermin.

Decreases in pain were only evident with celecoxib (standardized mean difference [SMD], −0.18) and glucosamine sulfate (SMD, −0.29). For all other estimates, there was large uncertainty compared to placebo.

Associations with improvement in joint space narrowing were found for glucosamine sulfate (SMD, −0.42 [95% CrI, −0.65 to −0.19]), chondroitin sulfate (SMD, −0.20 [95% CrI, −0.31 to −0.07]), and strontium ranelate (SMD, −0.20 [95% CrI, −0.36 to −0.05]).

These analyses again underscore the lack of good clinical trial designs, outcome measures and outcomes for the most prevalent form of arthritis - osteoarthritis of the knee. 

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Tramadol May be Associated with Increased Mortality in Osteoarthritis

JAMA reports that tramadol use in adults with osteoarthritis (OA) may be associated with increased all-cause mortality (compared with nonsteroidal anti-inflammatory drugs).

TKR - One or Two at a Time?

His would-be surgeon tried mightily to talk him out of a bilateral knee replacement. At 340 pounds, the patient's BMI -- above 43 -- was a significant contraindication. 

But the patient -- Nick Yphantides, MD, chief medical officer for California's San Diego County -- told MedPage Today he "aggressively" insisted, threatening to find another surgeon if he had to.

Older Men Less Likely to be Assessed and Treated for Osteoporosis

A study from the University of Washington in Seattle find that men with osteoporosis were less likely to be assessed by dual-energy X-ray absorptiometry (DXA); vitamin D measurements and were less like to receive calcium/vitamin D and bisphosphonate prescriptions. 

Hip Replacements Lasting 25 Years

Lancet reports that, based on a literature review and metanalysis, patients and surgeons can expect a hip replacement to last 25 years in around 58% of patients.

In the USA, there is an estimated 400,000 total hip arthroplasties (THA) annually. UK invesigators set out to answer the question: how long does a hip replacement last?

Opioid Use in Osteoarthritis Varies by State

A study in Arthritis & Rheumatology shows that there is substantial statewide variation in rates of treatment with long‐term opioid therapy in osteoarthritis - not fully explained by differences in access to healthcare providers, varying case‐mix, or state‐level policies.