Relative Efficacy and Safety of Anti-Inflammatory Biologic Agents for Osteoarthritis: A Conventional and Network Meta-Analysis

Abstract

Previous studies have consistently revealed that both local and systemic inflammations are the key to the onset and progression of osteoarthritis (OA). Thus, anti-inflammatory biologic agents could potentially attenuate the progression of OA. We conducted this meta-analysis to examine the efficacy and safety of ant-inflammatory biologic agents among OA patients. Methods: Five databases were searched for randomized controlled trials (RCTs) comparing biologics with placebo or each other in OA patients. Data of pain, physical function, stiffness, and adverse events (AEs) were extracted for a conventional and a Bayesian network meta-analysis. Results: 15 studies with data for 1566 patients were analyzed. In the conventional meta-analysis, etanercept (SMD −0.47; 95% CI −0.89, −0.05) and infliximab (SMD −2.04; CI −2.56, −1.52) were superior to placebo for knee pain. In the network meta-analysis, infliximab was superior to all the other biologic agents in improving pain (vs. hyaluronic acid (SMD −22.95; CI −34.21, −10.43), vs. adalimumab (SMD −21.71; CI −32.65, −11.00), vs. anakinra (SMD −24.63; CI −38.79, −10.05), vs. canakinumab (SMD −32.83; CI −44.45, −20.68), vs. etanercept (SMD −18.40; CI −29.93, −5.73), vs. lutikizumab (SMD −25.11; CI −36.47, −14.78), vs. naproxen (SMD −30.16; CI −41.78, −17.38), vs. tocilizumab (SMD −24.02; CI −35.63, −11.86) and vs. placebo (SMD −25.88; CI −34.87, −16.60)). No significant differences were observed between biologics and placebo regarding physical function, stiffness, and risk of AEs. Conclusions: The findings suggest that infliximab may relieve pain more than other biological agents in OA patients. No significant differences were observed between biologics and placebo regarding physical function, stiffness, and risk of AEs. The results must be interpreted cautiously; therefore, further randomized controlled trials are warranted.

Comparisons of Cytokines, Growth Factors and Clinical Efficacy between Platelet-Rich Plasma and Autologous Conditioned Serum for Knee Osteoarthritis Management

“…The investigators noticed that inflammatory factor levels escalated in patients with knee OA [ 12 , 13 , 14 ]. Developing targeting treatment of the factors, such as synthetic IL-1Ra anakinra or anti-inflammation biologics such as TNF inhibitors is straightforward, and the effects of some biologics have been evaluated and proven in patients with OA [ 41 ]. However, the cost of biologics is a barrier to approach.…”

Mechanisms of Peripheral and Central Sensitization in Osteoarthritis Pain

“…The evidence on the effectiveness of these drugs for OA pain is limited. A meta-analysis suggested that etanercept and infliximab were superior to placebo for pain in KOA, and infliximab was superior to the other biologic agents (adalimumab, anakinra, canakinumab, etanercept, naproxen, and tocilizumab) in improving pain in the hands and knees of OA [80]. In contrast, several clinical trials have been reported that specifically for OA of the hand, none seem to have shown the efficacy of a monoclonal antibody against TNF-α and IL-6 [81][82][83].…”

Knee Osteoarthritis—How Close Are We to Disease-Modifying Treatment: Emphasis on Metabolic Type Knee Osteoarthritis

“…However, the data should be confirmed in future studies as the conclusion regarding infliximab was drawn based on the results of two studies that incorporated 26 patients and combined data with different doses, routes of administration, and localizations of OA (hand and knee OA). The authors hypothesized that females and inflammatory phenotypes of OA with the presence of synovitis and effusion could be potential candidates for treatment with infliximab [ 26 ].…”