Efficacy and safety of hydroxychloroquine in osteoarthritis: a systematic review and meta-analysis of randomized controlled trials

Abstract

Background/Aims: Conventional disease-modifying anti-rheumatic drugs have been trialed in osteoarthritis (OA). Hydroxychloroquine (HCQ), which has shown its effectiveness in rheumatoid arthritis, has been trialed for the treatment of OA; however, its efficacy and safety remain unclear. This systematic review and meta-analysis evaluate efficacy and safety of HCQ for the treatment of OA. Methods: MEDLINE, EMBASE, and Cochrane Central were searched from inception through June 2020. Two reviewers independently screened for randomized controlled trials (RCTs) comparing HCQ with placebo or other active-comparators for the treatment of knee, hand, or hip OA, extracted data, and performed Cochrane risk of bias assessments. Results: Six RCTs, four in hand OA, two in knee OA, consisting of 842 patients (436 in HCQ arm, 406 in control arm) were included. RCTs were conducted between 2012 and 2020, one each at UK, Netherlands, Germany, Italy, Iran, and Egypt; follow-up period ranged 24 to 52 weeks. High-quality evidence showed no clinically important pain reduction with HCQ compared to placebo/active-control in hand OA (standardized mean difference [SMD], 0.14; 95% confidence interval [CI], -0.20 to 0.48). Effect on pain reduction in knee and hand OA was small and non-significant (SMD, -0.09; 95% CI, -0.44 to 0.25). High-quality evidence showed no improvement in dysfunction with HCQ compared to placebo in hand OA patients (SMD, 0.08; 95% CI, -0.23 to 0.40). Effect on dysfunction improvement in knee and hand OA was modest and statistically non-significant (SMD, -0.20; 95% CI, -0.57 to 0.18). No improvement in quality of life was observed in hand OA. Conclusions: HCQ has no benefit in reducing pain and improving physical function in hand or knee OA patients.

A Randomised Controlled Trial of YOGa and Strengthening Exercise for Knee OsteoArthritis: Protocol for a Comparative Effectiveness Trial (YOGA Trial)

“…Currently, there is no disease-modifying treatment option available for the management of OA. Consequently, OA imparts a substantial and increasing health burden, with notable implications for individuals and the healthcare systems globally [ 50 ].…”

Efficacy and safety of colchicine for the treatment of osteoarthritis: a systematic review and meta-analysis of intervention trials

“…Thirdly, in the majority of studies, we found heterogeneous population of patients with OA since did not consider different phenotypes such as imaging or inflammatory markers. Lastly, due to the insufficient data in some trials, SD values were imputed; however, we used the prescribed methods and assumptions [3,[26][27][28].…”

“…The final assessment is classified as "Low," or "High" risk of bias or can express "Some concerns". (3).…”

“…among the causes of global years lived with disability (YLD) [2] [2][3][4]. Despite the high prevalence and global impact of OA, there are no disease-modifying drugs approved for the treatment of OA that can arrest, slow, or reverse the progression of structural damage of the joint.…”

A Meta-Analysis of the Impact of Nutritional Supplementation on Osteoarthritis Symptoms

“…Knowledge of osteoarthritis (OA) has significantly improved in the last few decades [1][2][3]. Several treatments have been proposed for OA, including methotrexate, hydroxychloroquine, and tumor necrosis factor (TNF) inhibitors, but none are truly effective at alleviating OA symptoms [4][5][6]. Therefore, OA patients often try alternative and non-pharmacological treatments to decrease their pain and functional disability, despite little to no evidence of clinical efficacy [7,8].…”