Efficacy and safety of intra-articular therapies in rheumatic and musculoskeletal diseases: An overview of systematic reviews

Publikation: Bidrag til tidsskrift › Review › Forskning › fagfællebedømt

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  • Sebastián Cruz Rodriguez-García
  • Raul Castellanos-Moreira
  • Jacqueline Uson
  • Esperanza Naredo
  • Terence W. O'Neill
  • Michael Doherty
  • Boesen, Mikael Ploug
  • Hemant Pandit
  • Ingrid Möller Parera
  • Valentina Vardanyan
  • Terslev, Lene
  • Will Uwe Kampen
  • Maria Antonieta D'Agostino
  • Francis Berenbaum
  • Elena Nikiphorou
  • Irene Pitsillidou
  • Jenny De La Torre-Aboki
  • Loreto Carmona

Objective To summarise the evidence on intra-articular therapies (IAT) to inform the 2020 EULAR recommendations. Methods An overview of systematic reviews (SR) including randomised-controlled trials (RCTs) of IAT in adults with arthropathies was performed up to July 2020. Pain, function, and frequency of adverse events were the main efficacy and safety outcomes, respectively. Quality was assessed with the A MeaSurement Tool to Assess Systematic Reviews (AMSTAR)-2 tool. Results Of 184 references identified, 16 met the inclusion criteria, and a search of their reference lists identified 16 additional SRs. After quality assessment, 29 were finally included. Of these, 18 focused on knee osteoarthritis (KOA), 6 on hip osteoarthritis (HOA), 3 on shoulder capsulitis (SC), and 3 on rheumatoid arthritis. Overall, hyaluronic acid showed a small effect on pain and function in KOA but not in HOA or shoulder capsulitis. Intra-articular glucocorticoids showed a small effect in pain and function in KOA and function in HOA and SC. Platelet-rich plasma showed benefit in pain and function in KOA but not in HOA. Mesenchymal stem cells behaved similarly. Most SR results were of moderate quality and RCTs included often presented a high risk of bias, mainly due to inadequate blinding and heterogeneous results. All interventions were well tolerated with no clear safety differences. Conclusions This overview underlines that most IAT currently used in KOA, HOA, and SC exert small effects and are well tolerated. However, no firm conclusions can be drawn for inflammatory arthritis due to the limited data found.

OriginalsprogEngelsk
Artikelnummer001658
TidsskriftRMD Open
Vol/bind7
Udgave nummer2
Sider (fra-til)1-20
ISSN2056-5933
DOI
StatusUdgivet - 2021

Bibliografisk note

Funding Information:
Competing interests SCR-G reports grants from The Spanish Rheumatology Foundation during the conduct of the study, and personal fees from Roche, Sanofi, MSD, UCB-Pharma, Bristol-Myers-Squibb and Novartis and non-financial support from Lilly, Pfizer, Sanofi, MSD, Abbvie, UCB-Pharma, outside the submitted work. MD has received personal fees for advisory boards from Grunenthal, Mallinckrodt and Pfizer, and author royalties from UpToDate, and was an investigator in an AstraZeneca-funded, non-drug study (the ‘Sons of Gout’ study), unrelated to this work. LT has received speakers fee from AbbVie, Janssen, Roche, Novartis, Pfizer, MSD, BMS and GE. FB reports personal fees from Boehringer, Bone Therapeutics, Expanscience, Galapagos, Gilead, GSK, Merck Serono, MSD, Nordic, Novartis, Pfizer, Regulaxis, Roche, Sandoz, Sanofi, Servier, UCB, Peptinov, TRB Chemedica, 4P Pharma, outside the submitted work. LC declares that her institute receives grants for studies and research courses from Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA.

Funding Information:
This study was supported by a EULAR Task force grant CL109.

Funding Information:
Twitter Sebastián Cruz Rodriguez-García @sdlcrodriguez, Raul Castellanos-Moreira @raul_cast_morei, Elena Nikiphorou @ElenaNikiUK and Loreto Carmona @carmona_loreto Acknowledgements The authors want to acknowledge the kind supervision of the search strategy by Maria Piedad Rosario-Lozano, from the Agency of Technology Evaluation of Andalusia, Fundación Pública Andaluza Progreso y Salud.This paper presents independent research supported by the National Institute for Health Research (NIHR) Leeds Biomedical Research Centre (BRC). Professor Pandit is a NIHR Senior Investigator. The views expressed in this article are those of the author(s) and not necessarily those of the NIHR, or the Department of Health and Social Care.

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