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Medication Largely Ineffective In Long-Term Osteoarthritis Pain Management

A growing uncertainty continues to be made among pharmacological interventions for this chronic joint condition

A PPM Brief

Although osteoarthritis (OA) is a chronic and progressive disease, pharmacological agents are mainly studied over short-term periods, resulting in unclear recommendations for long-term use. In fact, a systematic review and meta-analysis1 of pharmacological interventions in 47 randomized clinical trials (RCTs) including just over 22,000 patients with knee OA found that there was uncertainty around the estimates of effect size for change in pain with placebo, including two medications that were associated with improved pain (celecoxib and glucosamine sulfate).

Researchers analyzed long-term (at least 12 months) RCT outcomes (symptoms, joint structure) from patients with knee osteoarthritis that had treatment and follow-up lasting 1 year or longer. The primary outcome was the mean change from baseline in knee pain, whereas secondary outcomes were physical function and joint structure. Standardized mean differences (SMDs) and mean differences with 95% credibility intervals (95% CrIs) were calculated, and findings were interpreted as associations when the 95% CrIs excluded the null value.

A growing uncertainty continues to be made among pharmacological interventions for this chronic joint condition. (Source: 123RF)

A total of 31 interventions were studied for pain, including 13 for physical function, and 16 for joint structure, where the trials ranged from 1 to 4 years. The RCTs (mean age of 55 to 70 years, with a higher mean proportion [70%] of women than men) included the following medication categories:

  • analgesics
  • antioxidants
  • bone-acting agents such as bisphosphonates and strontium ranelate
  • nonsteroidal anti-inflammatory drugs
  • intra-articular injection medications such as hyaluronic acid and corticosteroids
  • symptomatic slow-acting drugs such as glucosamine and chondroitin sulfate
  • putative disease-modifying agents, such as cindunistat and sprifermin.

Few associations were made in the review:

  • Decreases in pain were found for the NSAID celecoxib (SMD, −0.18 [95% CrI, −0.35 to −0.01]) and the symptomatic slow-acting drug glucosamine sulfate (SMD, −0.29 [95% CrI, −0.49 to −0.09]), but researchers noted that there was large uncertainty for all estimates vs placebo.
  • Pain improvement remained significant only for glucosamine sulfate (when data were analyzed using the mean difference on a scale from 0 to 100 and when trials at high risk of bias were excluded).
  • Only 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]) were associated with improvement in joint space narrowing.

The researchers concluded that larger RCTs are needed to resolve the uncertainty around the efficacy of medications for osteoarthritis.

Last updated on: January 25, 2019
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