Effectiveness of various corticosteroids for the management of knee and hip osteoarthritis: a systematic review and network meta-analysis

Abstract

Purpose: We aimed to assess the effectiveness of different preparations and doses of intra-articular corticosteroid (IACS) for knee and hip osteoarthritis in a network meta-analysis. Methods: Electronic databases including MEDLINE, Embase, Cochrane Library, Web of Science, and Cinahl were searched through for randomized controlled trials (RCTs) comparing any IACS with control interventions or with each other until March 15, 2018. The primary outcome was the pain relief, function improvement and adverse events. Bayesian network meta-analysis was used to combine both the direct and indirect evidence on treatment effectiveness. This study was registered on the PROSPERO (CRD42018091518). Results: From a total of 586 citations, 27 randomized trials with a total of 2242 participants were included in this network meta-analysis. 11 IACSs were considered. As for pain relief, Triamcinolone 20mg (SUCRA: 71.91%) got the highest, and Triamcinolone 80mg (SUCRA: 71%) and Triamcinolone 40mg (SUCRA: 59.45%) got the second and third probability in the network-analysis, respectively(Fig.1a). As for function improvement, Triamcinolone 80mg (SUCRA: 77.40%) got the highest probability, and Triamcinolone 40mg (SUCRA: 71.50%) and Triamcinolone 10mg (SUCRA 69.00%) got the second and third probability, respectively (Fig.1b). These estimates barely changed in sensitivity analysis. Conclusions: Our findings indicate that Triamcinolone 80mg seems to be the most promising pain relief and functional improvement preparation and dosing for the management of knee and hip OA. However, evidence was limited due to the heterogeneity and the small number of included trials.