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Review
. 2020 Jul 24;7(8):42.
doi: 10.3390/medicines7080042.

Autologous Mesenchymal Stem Cell Treatment is Consistently Effective for the Treatment of Knee Osteoarthritis: The Results of a Systematic Review of Treatment and Comparison to a Placebo Group

Chadwick Prodromos  1 , Susan Finkle  1 , Tobias Rumschlag  1 , John Lotus  1
Affiliations
Review

Autologous Mesenchymal Stem Cell Treatment is Consistently Effective for the Treatment of Knee Osteoarthritis: The Results of a Systematic Review of Treatment and Comparison to a Placebo Group

Chadwick Prodromos et al. Medicines (Basel). .

Abstract

Background: Numerous studies have used autologous mesenchymal stem cell injections (AMSCI) to treat osteoarthritis. We hypothesized that AMSCI is an effective osteoarthritis treatment with increasing efficacy at higher doses. Methods: We conducted a PubMed search for human clinical studies using AMSCI for the treatment of osteoarthritis (OA) and a second search for placebo arms of injectate OA treatment. Inclusion criteria included treatment outcomes ratings both pre-treatment and at least 6 months post-treatment. Results: 45 AMSCI cohorts from 34 studies met criteria. All AMSCI cohorts showed improvement at mean 15.3 months post-treatment. Mean WOMAC and VAS scores improved at 6-months and at final follow-up (p < 0.0001 for all). Scores > 2 years were also significant (WOMAC p = 0.001/VAS p = 0.004). Results greatly exceeded the minimal clinically important difference (MCID) at each time point. AMSCI improvement also substantially exceeded previously published 6-month placebo-treatment improvement. No dose-response relationship was seen. AMSCI cohorts showed continuing improvement ≥ 6 months, and continued upward at one year. Placebo scores were already trending downward by 6 months. Conclusions: AMSCI is a consistently significantly effective treatment for osteoarthritis. It should no longer be stated that data is insufficient to establish AMSCI efficacy for OA. Given its excellent safety profile, AMSCI should be widely used for the treatment of osteoarthritis.

Keywords: adipose tissue; autologous; bone marrow aspirate; knee osteoarthritis; mesenchymal stem cell; stem cell.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram—study selection process.
Figure 2
Figure 2
(A) Intermediate and long-term mean improvement in WOMAC scores starting from 6 months post-treatment. Vertical bars indicate 95% confidence interval. (B) Intermediate and long-term mean improvement in VAS scores starting from 6 months post-treatment. Vertical bars indicate 95% confidence interval.
Figure 3
Figure 3
(A) Comparison of maximum mean WOMAC improvement before 3 months post-treatment compared to 6 months post-treatment for Group 1 and placebo patients. Vertical bars indicate 95% confidence interval. Comparison of means between Group 1 and placebo was p = 0.02 at ≤3 months and p =< 0.0001 at 6 months. (B) Comparison of maximum mean VAS improvement before 3 months post-treatment compared to 6 months post-treatment for Group 1 and placebo patients. Vertical bars indicate 95% confidence interval. Comparison of means between Group 1 and placebo was p =0.02 at ≤3 months and p = 0.001 at 6 months.
Figure 4
Figure 4
(A) MCID Ratio at Last Follow-up for Cultured ASC vs MSC Dose. (B) MCID Ratio at Last Follow-up for Cultured BMSC vs MSC Dose. (C) MCID Ratio at Last Follow-up for SVF vs TNC Dose.
Figure 4
Figure 4
(A) MCID Ratio at Last Follow-up for Cultured ASC vs MSC Dose. (B) MCID Ratio at Last Follow-up for Cultured BMSC vs MSC Dose. (C) MCID Ratio at Last Follow-up for SVF vs TNC Dose.
See this image and copyright information in PMC

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