摘要
目的比较骨关节炎5种药物(对乙酰氨基酚、塞来昔布、氨基葡萄糖、硫酸/盐酸软骨素、氨基葡萄糖和软骨素联合)疗效和不良反应并进行概率排序。方法系统检索电子数据库中公开发表关于对乙酰氨基酚、塞来昔布、氨基葡萄糖、硫酸/盐酸软骨素、安慰剂随机对照试验(截止日期为2017年10月)。通过贝叶斯网络Meta和传统Meta分析相对和绝对疗效及不良反应。结果共纳入58篇文献,包含25 045例患者的61个随机对照试验。研究表明,在缓解疼痛方面,塞来昔布优于其他方案(SMD=-0.32,95%CI:-0.38^-0.25),其次为关节保护药物。在提高功能方面,除对乙酰氨基酚以外(SMD=-0.14,95%CI:-0.27~0.01)均优于安慰剂。改善僵直方面,氨基葡萄糖(SMD=-0.36,95%CI:-0.67^-0.06)与塞来昔布(SMD=-0.29,95%CI:-0.51^-0.08)优于其他方案。塞来昔布虽然在疗效方面效果显著,但最有可能出现不良反应事件;关节保护类药物也有较为显著表现,且具有较低不良事件发生率。对乙酰氨基酚相对疗效最差且具有较高不良事件发生率。结论塞来昔布优于其他药物,但不良反应发生率较高。关节保护类药物也具有较好疗效且不良反应发生率较低。
Objective To compare the efficacy and adverse effect of acetaminophen, celecoxib, glucosamine, chondroitin sul- fate, and combination of glucosamine and cbondroitin sulfate on the treatment of osteoarthritis. Methods We systematically searched all potential studies published from the inception to October 2017 in electronic database that were randomized control trials design. Bayesian network Meta-analysis and traditional Meta-analysis were used to evaluate and compare the efficacy and safety of these treatments. Results We identified 58 papers that contained 61 randomized controlled trials, including 25 045 patients. Network Meta-analysis demonstrated that celecoxib was significantly superior to other treatments on pain relief （SMD = -0. 32,95% CI： -0. 38- -0. 25）, followed by the symptomatic slow-acting drugs. For physical function improvement, all interventions were significantly supe- rior to oral placebo except acetaminophen （ SMD = - 0. 14,95% CI： - 0. 27-0. 01 ）. In terms of stiffness, glucosamine （ SMD = i - 0. 36,95 % CI： - 0. 67- - 0.06） and celecoxib （ SMD = - 0.29,95 % CI ： - 0. 51- - 0. 08 ） outperformed than placebo. Although celecoxib had significant efficacy, it was accused of an increased risk adverse events. Symptomatic slow-acting drugs had shown a sig- nificant treatment effect accompanied with remarkable safety. Acetaminophen seemed to be the least efficacious intervention option and the most adverse events. Conclusions Given the effectiveness of these Non-steroidal anti-inflammatory drugs and symptomatic slow-act- ing drugs, oral celecoxib is significantly superior to other treatments on relieving pain, but it has relatively high incidence rate of adverse effect. Symptomatic slow-acting drugs also performs relatively superb efficacy and has relatively low incidence rate of adverse effect.
作者
朱晓玥
沈俊杰
桑灵丽
姜丽英
ZHU Xiao- yue;SHEN Jun-jie;SANG Ling-li;JIANG Li-ying(Department of Epidemiology, School of Public Health, Nantong Universi- ty, Nantong 226019, China;Shanghai Key Laboratory for Molecular Imaging, Shanghai University of Medicine ＆ Health Sci- ences, Shanghai 201318, China)
出处
《中华疾病控制杂志》
CAS
CSCD
北大核心
2018年第4期396-401,共6页
Chinese Journal of Disease Control & Prevention
基金
江苏省大学生创新创业训练计划项目(201710304058Z)
