Uncertain Long Term Efficacy in Trials of Knee Osteoarthritis Save

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.