|Pharmaceutical agents in pain control of
|Osteoarthritis is one of the most common chronic diseases, and a major cause of disability. A great number of efforts have been put on short-term pain control, which ignores long-term outcomes. To address the association between pharmacological agents in knee osteoarthritis and long-term outcomes of pain control, Dr. Rovati and colleagues conducted this network meta-analysis and published their results in a recent issue of JAMA (here).
A total of 47 randomized clinical trials (22,037 patients) with a duration between 1 and 4 years were analyzed in this study. The pharmaceutical interventions were categorized into: analgesics; antioxidants; bone-acting agents like bisphosphonates and strontium ranelate; nonsteroidal anti-inflammatory drugs; intra-articular injection agents like hyaluronic acid and corticosteroids; symptomatic slow-acting agents like glucosamine and chondroitin sulfate; and putative disease-modifying agents like cindunistat and sprifermin. Associations with decreases in pain were detected in administration of the anti-inflammatory drug celecoxib (standardized mean differences [SMD], -0.18; 95% credibility intervals [Crl], -0.35 to -0.01) and the symptomatic slow-acting drug glucosamine sulfate (SMD, -0.29; 95% Crl, -0.49 to -0.09). However, there was large uncertainty for all estimates of effect size.
Due to the large uncertainty of estimates of effect size in long-term pain control using pharmaceutical agents in knee osteoarthritis patients, larger randomized clinical trials are warranted to address the efficacy of medications.