Abstract
Objective Most guidelines recommend the use of nonsteroidal anti-inflammatory drugs (NSAIDs), duloxetine, and tramadol for the nonoperative treatment of osteoarthritis (OA), but the use of them is limited by the tolerability and safety concerns. Lutikizumab is a novel anti–IL-1α/β dual variable domain immunoglobulin that can simultaneously bind and inhibit IL-1α and IL-1β to relieve the pain and dysfunction symptoms. We conducted this network meta-analysis to comprehensively compare the clinical efficacy and safety of lutikizumab with other drugs recommended by guidelines. Methods We conducted a Bayesian network and conventional meta-analyses to compare the efficacy and safety of lutikizumab with other traditional drugs. All eligible randomized clinical trials, in PubMed, CNKI, EMBASE, and Web of Science databases, from January 2000 to January 2020, were included. The Cochrane risk of the bias assessment tool was used for quality assessment. Pain relief, function improvement, and risk of adverse effects (AEs) were compared in this study. Results 24 articles with 11858 patients were included. Duloxetine (DUL) had the largest effect for pain relief (4.76, 95% CI [2.35 to 7.17]), and selective cox-2 inhibitors (SCI) were the most efficacious treatment for physical function improvement (SMD 3.94, 95% CI [2.48 to 5.40]). Lutikizumab showed no benefit compared with placebo for both pain relief (SMD 1.11, 95% CI [-2.29 to 4.52]) and function improvement (SMD 0.992, 95% CI [-0.433 to 4.25]). Lutikizumab and all other drugs are of favorable tolerance for patients in the treatment of OA compared with placebo. Conclusions Lutikizumab, the new anti–Interleukin-1α/β dual variable domain immunoglobulin, showed no improvement in pain or function when compared with placebo. Selective cox-2 inhibitors and duloxetine remain the most effective and safest treatment for OA. More high-quality trials are still needed to reconfirm the findings of this study.
Highlights
Osteoarthritis (OA) is the most common form of joint disease, usually affecting load-bearing joints such as hip and knee joints [1]
We conducted a systematic search of the PubMed, CNKI, EMBASE, and Web of Science databases, from January 2000 to January 2020, with the search terms consisted of ((“Lutikizumab” odds ratio (OR) “anti-Interleukin1α/β dual variable domain immunoglobulin” OR “anti-Interleukin-1α/β”) OR (“selective cox-2 inhibitor” OR “cox-2 inhibitor” OR “etoricoxib” OR “celecoxib”) OR (“nonsteroidal antiinflammatory drugs (NSAIDs)” OR “non-steroidal anti-inflammatory drugs” OR “acetaminophen” OR “diclofenac” OR “naproxen” OR “paracetamol” OR “ibuprofen”) OR (“duloxetine”) OR (“opioids” OR “Tramadol”) AND (“osteoarthritis” OR “degenerative joint disease” OR “OA”))
No treatment showed a higher risk of any safety endpoint (Supplementary Appendix Table 5). This is the first network meta-analysis comparing the efficacy and safety of lutikizumab, the new anti–Interleukin-1α/β dual variable domain immunoglobulin, for treating OA with drugs recommended by guidelines [2]
Summary
Osteoarthritis (OA) is the most common form of joint disease, usually affecting load-bearing joints such as hip and knee joints [1]. 302 million people suffer from OA worldwide every year [2]. OA can lead to local pain and joint stiffness in its early stages and can cause dysfunction and even disability in the late stages. OA-related pain and dysfunction increase the risk of mortality [3] as well as the societal economic burden [4]. To address the health issue, most guidelines recommend the use of nonsteroidal antiinflammatory drugs (NSAIDs), duloxetine, or tramadol for nonoperative treatment of OA [2]. The use of these drugs is limited by tolerability and safety concerns [5]
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