A comparative study of the efficacy of intra-articular injection of different drugs in the treatment of mild to moderate knee osteoarthritis: A network meta-analysis

Abstract

Background: Knee osteoarthritis (KOA) has a high clinical prevalence and frequently interferes with patients normal lives. In KOA patients, evidence suggests that intra-articular (IA) injection improves joint function and decreases discomfort. Several IA injection treatments are used in daily practice to improve symptomatic control of knee osteoarthritis, but their efficacy is frequently disputed. Methods: This network meta-analysis compares the efficacy of different IA injections for mild to moderate knee osteoarthritis. Seven databases (PubMed, EMBASE, Web of Science, Cochrane Library, China Biology Medicine disc, WanFang, and China National Knowledge Infrastructure) were searched for randomized controlled trials published up to and including December 20, 2021, and final follow up indicators were used. Visual analogue scale (VAS) score and The Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index (WOMAC) score change from baseline were the primary outcomes. We used the Cochrane risk of bias tool to assess the quality and risks of biases of papers. We calculated the weighted mean difference (WMD) and 95% confidence interval (CI) for each outcome. State (Version 15.1, Texas, USA) and SPSS (Version 20, Chicago, USA) was used in all statistical analyses, and Review Manager (version 5.4) was used in assessing the risks of biases. Results: Our study included 16 randomized controlled trials with a total of 1652 patients. platelet-rich plasma (PRP) IA injection therapy had the highest likelihood of being the best intervention in reducing WOMAC pain (surface under the cumulative ranking area [SUCRA] 84.7%), stiffness (SUCRA 95.1%), and function (SUCRA 98.5%) scores, according to the SUCRA. The best measures for lowering the WOMAC total and VAS scores were IA injection platelet-rich plasma-derived growth factor (SUCRA 84.9%) and hyaluronic acid and platelet-rich plasma (SUCRA 84.9%). In the VAS score group, PRP outperformed hyaluronic acid (HA) (WMD 1.3, 95% CI 0.55–2.55) and corticosteroids (CS) (WMD 4.85, 95% CI 4.02–5.08), according to the forest map results. PRP also outperformed CS (WMD 14.76, 95% CI 12.11–17.41), ozone (WMD 9.16, 95% CI 6.89–11.43), and PRP + HA (WMD 2.18, 95% CI 0.55–3.81) in the WOMAC total score group. Furthermore, PRP outperforms other drugs in terms of reducing WOMAC function, stiffness, and function score. Conclusion: In patients with mild to moderate KOA, IA injection PRP outperformed IA injection ozone, HA, CS, platelet-rich plasma-derived growth factor, and hyaluronic acid and platelet-rich plasma in terms of pain, stiffness, and dysfunction.

Comparative study between intra articular injection of ozone with corticosteroids versus plasma rich in growth factors in limitation of pain in knee osteoarthritis

“…Our findings also addressed, a higher reduction was documented as regards pain score and analgesic requirement in ozone group at short-term (1-month post injection), but at long term (3 and 6-months post injection) there was higher reduction in pain score and analgesic requirement in PRGF group. Supporting out findings, Raeissadat et al [3] and Xue et al [19] showed that PRGF injections have the best longterm outcome in terms of pain reduction, and consequently reduction in analgesic requirement compared to other treatment modalities including ozone injection. Also, Gaballa et al [20] and Duymus et al [21] addressed, PRP injection have better long-term outcome in terms of pain reduction, and consequently reduction in analgesic requirement compared to ozone injection.…”

“…Indicating better long-term outcome in PRGF group. This was supported by the meta-analysis by Xue et al [19] addressing, PRGF was associated with better prolonged outcomes as opposed to ozone treatment. After one month knee flexion exhibited significantly greater values within O group in comparison with P group (P=0.004) (improvement in ROM).…”

“…Also, a recent network meta-analysis including 16 RCTs. It involved 1652 patients by Xue et al [19] addressed, the most effective methods for reducing VAS scores were IA injection of PRP-derived GFs (surface under the cumulative ranking area [SUCRA] 84.9%) and HA and PRP (SUCRA 84.9%). The comparison between the studied groups addressed no significant variations among both studied groups before injection, 1 week and 3 months following injection (p>0.05 for all).…”

Current Approaches to Four Challenging Pain Syndromes

“…Methotrexate and ozone therapy are also described in the literature [ 40 ]. Hyaluronic acid injections (viscosupplementation) and platelet-rich plasma injections are being evaluated [ 41 ]. Intra-articular injections may be guided by landmarks, fluoroscopy, or ultrasound, with excellent evidence available for ultrasound-guided procedures.…”

A commentary on ‘A model-based quantitative analysis of efficacy and associated factors of platelet rich plasma treatment for osteoarthritis’

“…Clinical treatment involves a step-wise strategy, and systematic conservative treatment is usually adopted for early- and middle-stage OA. The non-surgical treatments for OA now mainly include nonsteroidal anti-inflammatory drugs (NSAIDs), intra-articular injections of platelet-rich plasma (PRP), hyaluronic acid (HA), steroids, and mesenchymal stem cells (MSCs) 3 . Among them, HA is a high-molecular-weight biological polysaccharide, which can play a role in chondroprotection both in vivo and in vitro .…”