Comparative effectiveness of pharmacological interventions for hand osteoarthritis: a systematic review and network meta-analysis of randomised trials
Margreet Kloppenburg,
Ida K Haugen,
Féline PB Kroon,
Robin Christensen,
Marius Henriksen,
Henning Bliddal,
Lisa Stamp,
Mikael Boesen,
Sabrina Mai Nielsen,
Simon Tarp,
Soren Berg,
Anna Dossing,
Roy D Altman,
Ida Maria Balsby
Affiliations
Margreet Kloppenburg
Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
Ida K Haugen
Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
Féline PB Kroon
Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
Robin Christensen
The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
Marius Henriksen
The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
Henning Bliddal
Bispebjerg and Frederiksberg Hospital, University of Copenhagen, The Parker Institute, Copenhagen, Denmark
Lisa Stamp
Department of Medicine, Christchurch, University of Otago, Christcurch, Christcurch, New Zealand
Mikael Boesen
Department of Radiology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
Sabrina Mai Nielsen
Section for Biostatistics and Evidence-Based Research, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, The Parker Institute, Copenhagen, Denmark
Simon Tarp
Bispebjerg and Frederiksberg Hospital, University of Copenhagen, The Parker Institute, Copenhagen, Denmark
Soren Berg
Bispebjerg and Frederiksberg Hospital, The Parker Institute, Copenhagen, Denmark
Anna Dossing
The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
Roy D Altman
Division of Rheumatology and Immunology, the University of California at Los Angeles (UCLA), David Geffen School of Medicine, Los Angeles, California, USA
Ida Maria Balsby
Bispebjerg and Frederiksberg Hospital, University of Copenhagen, The Parker Institute, Copenhagen, Denmark
Objective To explore the comparative effectiveness of pharmacological interventions for hand osteoarthritis (OA).Methods We systematically searched Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials from inception until 26 December 2021, for randomised trials of pharmacological interventions for people with hand OA. Two reviewers independently extracted study data and assessed the risk of bias. We calculated the effect sizes for pain (standardised mean differences) using Bayesian random effects models for network meta-analysis (NMA) and pairwise meta-analysis. Based on a pre-specified protocol, we prospectively registered the study at PROSPERO, CRD42021215393.Results We included 72 trials with 7609 participants. 65 trials (n=5957) were eligible for the quantitative synthesis, investigating 29 pharmacological interventions. Oral non-steroidal anti-inflammatory drugs (NSAIDs) and oral glucocorticoids’ NMA effect sizes were −0.18 (95% credible interval −0.36 to 0.02) and −0.54 (−0.83 to −0.24), respectively, compared with placebo, and the result was consistent when limiting evidence to the pairwise meta-analysis of trials without high risk of bias. Intra-articular hyaluronate, intra-articular glucocorticoids, hydroxychloroquine, and topical NSAIDs’ NMA effect sizes were 0.22 (−0.08 to 0.51), 0.25 (0.00 to 0.51), −0.01 (−0.19 to 0.18), and −0.14 (−0.33 to 0.08), respectively, compared with placebo. Oral NSAIDs were inferior to oral glucocorticoids with an NMA effect size of 0.36 (0.01 to 0.72). No intervention was superior to placebo when stratifying for thumb and finger OA.Conclusion Oral NSAIDs and glucocorticoids are apparently effective pharmacological interventions in hand OA. Intra-articular therapies and topical NSAIDs were not superior to placebo.
