Abstract
Background: Numerous studies have used autologous mesenchymal stem cell injections (AMSCI) to treat osteoarthritis. We hypothesized that AMSCI is an effective osteoarthritis treatment with increasing efficacy at higher doses. Methods: We conducted a PubMed search for human clinical studies using AMSCI for the treatment of osteoarthritis (OA) and a second search for placebo arms of injectate OA treatment. Inclusion criteria included treatment outcomes ratings both pre-treatment and at least 6 months post-treatment. Results: 45 AMSCI cohorts from 34 studies met criteria. All AMSCI cohorts showed improvement at mean 15.3 months post-treatment. Mean WOMAC and VAS scores improved at 6-months and at final follow-up (p < 0.0001 for all). Scores > 2 years were also significant (WOMAC p = 0.001/VAS p = 0.004). Results greatly exceeded the minimal clinically important difference (MCID) at each time point. AMSCI improvement also substantially exceeded previously published 6-month placebo-treatment improvement. No dose–response relationship was seen. AMSCI cohorts showed continuing improvement ≥ 6 months, and continued upward at one year. Placebo scores were already trending downward by 6 months. Conclusions: AMSCI is a consistently significantly effective treatment for osteoarthritis. It should no longer be stated that data is insufficient to establish AMSCI efficacy for OA. Given its excellent safety profile, AMSCI should be widely used for the treatment of osteoarthritis.
Highlights
Osteoarthritis afflicts tens of millions of people worldwide, resulting in tremendous morbidity and economic costs [1]
Results arms with different autologous mesenchymal stem cell injections (AMSCI) treatments, resulting in 38 treatment arm subgroups included in this analysis
34 studies were published in peer-reviewed journals thatwith examined injection of autologous AMSCI for the treatment of knee osteoarthritis and met our criteria for rating evaluation
Summary
Osteoarthritis afflicts tens of millions of people worldwide, resulting in tremendous morbidity and economic costs [1]. The most common, non-surgical treatments include use of oral pain medication including non-steroidal anti-inflammatory drugs (NSAIDs) and opiates, and joint injections with corticosteroids or hyaluronic acid (HA). All of these options have serious safety and efficacy issues. We hypothesized that AMSCI is an effective osteoarthritis treatment with increasing efficacy at higher doses. All AMSCI cohorts showed improvement at mean 15.3 months post-treatment. Mean WOMAC and VAS scores improved at 6-months and at final follow-up (p < 0.0001 for all). AMSCI cohorts showed continuing improvement ≥ 6 months, and continued upward at one year. Given its excellent safety profile, AMSCI should be widely used for the treatment of osteoarthritis
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