| Title | Viscosupplementation for knee osteoarthritis: systematic review and meta-analysis |
| Authors | Pereira, Tiago, V Jueni, Peter Saadat, Pakeezah Xing, Dan Yao, Liang Bobos, Pavlos Agarwal, Arnav Hincapie, Cesar A. da Costa, Bruno R. |
| Affiliation | St Michaels Hosp, Li Ka Shing Knowledge Inst, Appl Hlth Res Ctr, Toronto, ON, Canada Univ Leicester, Dept Hlth Sci, Leicester, England Univ Toronto, Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada Univ Toronto, Dept Med, Toronto, ON, Canada Peking Univ, Arthrit Clin & Res Ctr, Peoples Hosp, Beijing, Peoples R China McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada Western Univ, Sch Phys Therapy, Dept Hlth & Rehabil Sci, London, ON, Canada Balgrist Univ Hosp, Fac Med, Dept Chiropract Med, Zurich, Switzerland Univ Zurich, Zurich, Switzerland Univ Zurich, Epidemiol Biostat & Prevent Inst EBPI, Zurich, Switzerland |
| Keywords | SINGLE INTRAARTICULAR INJECTION HYALURONIC-ACID DOUBLE-BLIND SODIUM HYALURONATE CONTROLLED-TRIAL ASSESSING RISK MULTICENTER PLACEBO EFFICACY SALINE |
| Issue Date | 6-Jul-2022 |
| Publisher | BMJ-BRITISH MEDICAL JOURNAL |
| Abstract | OBJECTIVE To evaluate the effectiveness and safety of viscosupplementation for pain and function in patients with knee osteoarthritis.DESIGN Systematic review and meta-analysis of randomised trials. DATA SOURCES Searches were conducted of Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases from inception to 11 September 2021. Unpublished trials were identified from the grey literature and trial registries. ELIGIBILITY CRITERIA FOR STUDY SELECTION Randomised trials comparing viscosupplementation with placebo or no intervention for knee osteoarthritis treatment.MAIN OUTCOME MEASURES The prespecified primary outcome was pain intensity. Secondary outcomes were function and serious adverse events. Pain and function were analysed as standardised mean differences (SMDs). The prespecified minimal clinically important between group difference was-0.37 SMD. Serious adverse events were analysed as relative risks.METHODS Two reviewers independently extracted relevant data and assessed the risk of bias of trials using the Cochrane risk of bias tool. The predefined main analysis was based only on large, placebo controlled trials with >= 100 participants per group. Summary results were obtained through a random effects meta -analysis model. Cumulative meta-analysis and trial sequential analysis under a random effects model were also performed.RESULTS 169 trials provided data on 21 163 randomised participants. Evidence of small study effects and publication biases was observed for pain and function (Egger's tests with P<0.001 and asymmetric funnel plots). Twenty four large, placebo controlled trials (8997 randomised participants) included in the main analysis of pain indicated that viscosupplementation was associated with a small reduction in pain intensity compared with placebo (SMD-0.08, 95% confidence interval-0.15 to-0.02), with the lower bound of the 95% confidence interval excluding the minimal clinically important between group difference. This effect corresponds to a difference in pain scores of-2.0 mm (95% confidence interval-3.8 to-0.5 mm) on a 100 mm visual analogue scale. Trial sequential analysis for pain indicated that since 2009 there has been conclusive evidence of clinical equivalence between viscosupplementation and placebo. Similar conclusions were obtained for function. Based on 15 large, placebo controlled trials on 6462 randomised participants, viscosupplementation was associated with a statistically significant higher risk of serious adverse events than placebo (relative risk 1.49, 95% confidence interval 1.12 to 1.98). CONCLUSION Strong conclusive evidence indicates that viscosupplementation leads to a small reduction in knee osteoarthritis pain compared with placebo, but the difference is less than the minimal clinically important between group difference. Strong conclusive evidence indicates that viscosupplementation is also associated with an increased risk of serious adverse events compared with placebo. The findings do not support broad use of viscosupplementation for the treatment of knee osteoarthritis. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021236894. |
| URI | http://hdl.handle.net/20.500.11897/649648 |
| ISSN | 0959-535X |
| DOI | 10.1136/bmj-2022-069722 |
| Indexed | SCI(E) |
| Appears in Collections: | 人民医院 |
