Abstract
Objective Osteoarthritis (OA) is the most common degenerative joint disease, causing joint pain, stiffness, and even disability. Guidelines recommend intra-articular injections as an alternative treatment to relieve OA symptoms for patients who demonstrate poor tolerability or compliance to oral administration of drugs. Mesenchymal stem cells (MSCs) are a potential treatment for of OA. We conducted this network meta-analysis to comprehensively compare the efficacy and safety between hyaluronic acid (HA), corticosteroids (GCs), platelet-rich plasma (PRP), and MSCs. Design Systematic review and Bayesian network meta-analysis. Data Sources. Relevant studies, published from January 2000 to January 2020, in the PubMed, Cochrane library, EMBASE, and CKNI databases. Methods Bayesian network and conventional meta-analyses were conducted. Pain relief, functional improvement, improvement in joint stiffness, and risk of adverse effects (AEs) were assessed. Results Twenty-five articles with 4642 patients were included. Overall, MSC therapy was the most effective treatment for pain relief (standardized mean difference compared with placebo = 3.61, 95% CI [1.87 to 5.35]). Both MSC and PRP therapies improved every symptom of OA effectively and have an advantage over HA and GCs which are recommended by guidelines. MSCs, PRP, HA, and GCs are tolerated well for patients in long-term treatment of OA compared with placebo. Conclusions The results show that MSCs relieve pain, stiffness, and dysfunction due to OA better than PRP, HA, and GCs and are not statistically correlated with greater safety concerns. More high-quality trials are needed to reconfirm the findings of this study, however, standardization of preparation of MSCs and PRP should be investigated in the future.
Highlights
Osteoarthritis (OA) is a common joint disease characterized by cartilage defects, joint space narrowing, and osteophyte formation
Nonsteroidal anti-inflammatory drugs (NSAIDs), tramadol and duloxetine, which are usually recommended by most guidelines such as those of the American College of BioMed Research International
A clinical study with a 30-month follow-up period found that patients received mesenchymal stem cells (MSCs) treatments exhibiting significant therapeutic benefits without severe adverse events (AEs) [5], while a randomized clinical trial (RCT) has reported higher efficacy and safety for platelet-rich plasma (PRP) therapy compared with other treatments [6]
Summary
Osteoarthritis (OA) is a common joint disease characterized by cartilage defects, joint space narrowing, and osteophyte formation. Some limitations exist in their study design Foremost, they only compared the pain-scale value at 1, 3, and 6 months directly, ignoring the divergence among different outcome-scale baseline values of each group shown in the published papers. They only compared the pain-scale value at 1, 3, and 6 months directly, ignoring the divergence among different outcome-scale baseline values of each group shown in the published papers This may reduce the reliability of the results of their meta-analysis. To deepen the analysis of the effects of the four types of intra-articular therapies (MSCs, PRP, HA and GC), we compared the values of several additional efficacy endpoints, including pain relief, function, and reduction in stiffness, among the groups
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