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Review
. 2022 Jul 7;11(14):3958.
doi: 10.3390/jcm11143958.

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

Yang Li  1 , Yiying Mai  1 , Peihua Cao  1 , Xin Wen  1 , Tianxiang Fan  1 , Xiaoshuai Wang  1 , Guangfeng Ruan  1 , Su'an Tang  1 , Changhai Ding  1   2 , Zhaohua Zhu  1   2
Affiliations
Review

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

Yang Li et al. J Clin Med. .

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.

Keywords: biological therapy; inflammation; infliximab; meta-analysis; osteoarthritis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Detailed study selection process.
Figure 2
Figure 2
Network plot. (a), pain; (b), physical function; (c), stiffness; (d), adverse events; PBO, placebo; ADA, adalimumab; LUT, lutikizumab (ABT981); CAN, canakinumab; NAP, naproxen; HA, hyaluronic acid; ANA, anakinra; ETA, etanercept; INF, infliximab; SC, standard care; TOC, tocilizumab. The size of the circle represents the number of participants, and the thickness of the line represents the number of studies.
Figure 3
Figure 3
Risk of bias assessment. (a) judgements of each bias item presented as percentages across all included studies. (b) judgements of each bias item for each included study.
See this image and copyright information in PMC

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