Comparative effectiveness of oral pharmacotherapy in the treatment of osteoarthritis:network Meta-analysis
-
摘要: 目的 比较骨关节炎5种药物(对乙酰氨基酚、塞来昔布、氨基葡萄糖、硫酸/盐酸软骨素、氨基葡萄糖和软骨素联合)疗效和不良反应并进行概率排序。方法 系统检索电子数据库中公开发表关于对乙酰氨基酚、塞来昔布、氨基葡萄糖、硫酸/盐酸软骨素、安慰剂随机对照试验(截止日期为2017年10月)。通过贝叶斯网络Meta和传统Meta分析相对和绝对疗效及不良反应。结果 共纳入58篇文献,包含25 045例患者的61个随机对照试验。研究表明,在缓解疼痛方面,塞来昔布优于其他方案(SMD=-0.32,95%CI:-0.38~-0.25),其次为关节保护药物。在提高功能方面,除对乙酰氨基酚以外(SMD=-0.14,95%CI:-0.27~0.01)均优于安慰剂。改善僵直方面,氨基葡萄糖(SMD=-0.36,95%CI:-0.67~-0.06)与塞来昔布(SMD=-0.29,95%CI:-0.51~-0.08)优于其他方案。塞来昔布虽然在疗效方面效果显著,但最有可能出现不良反应事件;关节保护类药物也有较为显著表现,且具有较低不良事件发生率。对乙酰氨基酚相对疗效最差且具有较高不良事件发生率。结论 塞来昔布优于其他药物,但不良反应发生率较高。关节保护类药物也具有较好疗效且不良反应发生率较低。Abstract: Objective To compare the efficacy and adverse effect of acetaminophen, celecoxib, glucosamine, chondroitin sulfate, and combination of glucosamine and chondroitin sulfate on the treatment of osteoarthritis. Methods We systematically searched all potential studies published from the inception to October 2017 in electronic database that were randomized control trials design. Bayesian network Meta-analysis and traditional Meta-analysis were used to evaluate and compare the efficacy and safety of these treatments. Results We identified 58 papers that contained 61 randomized controlled trials, including 25 045 patients. Network Meta-analysis demonstrated that celecoxib was significantly superior to other treatments on pain relief (SMD=-0.32,95% CI:-0.38--0.25), followed by the symptomatic slow-acting drugs. For physical function improvement, all interventions were significantly superior to oral placebo except acetaminophen (SMD=-0.14,95% CI:-0.27-0.01). In terms of stiffness, glucosamine (SMD=-0.36,95% CI:-0.67--0.06) and celecoxib (SMD=-0.29,95% CI:-0.51--0.08) outperformed than placebo. Although celecoxib had significant efficacy, it was accused of an increased risk adverse events. Symptomatic slow-acting drugs had shown a significant treatment effect accompanied with remarkable safety. Acetaminophen seemed to be the least efficacious intervention option and the most adverse events. Conclusions Given the effectiveness of these Non-steroidal anti-inflammatory drugs and symptomatic slow-acting drugs, oral celecoxib is significantly superior to other treatments on relieving pain, but it has relatively high incidence rate of adverse effect. Symptomatic slow-acting drugs also performs relatively superb efficacy and has relatively low incidence rate of adverse effect.
-
Key words:
- Osteoarthritis /
- Pharmacotherapy /
- Adverse effect /
- Network Meta-analysis
点击查看大图
计量
- 文章访问数: 490
- HTML全文浏览量: 40
- PDF下载量: 28
- 被引次数: 0