Efficacy and safety of duloxetine in osteoarthritis: a systematic review and meta-analysis
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About 21% of adults with osteoarthritis (OA) are diagnosed with concomitant depression in addition to chronic pain. Duloxetine, an anti-depressant medication, has been recently approved for managing Knee OA. We performed a systematic review to ascertain the efficacy and safety of duloxetine for OA. We searched MEDLINE, EMBASE, Web of Science, Google Scholar, and the Cochrane Database from inception to December 2018. Randomized clinical trials (RCTs) assessing the efficacy and/or safety of duloxetine versus placebo in OA patients were included. Data extraction and quality assessment were undertaken by two independent reviewers. Seven RCTs (n = 2,102 participants) met our inclusion criteria, and five RCTs (n = 1,713) were eligible for meta-analysis. The results of our analyses indicate that duloxetine has statistically significant, moderate benefits on pain, function, and quality of life in knee OA patients for up to 13 weeks. Reported incidences of gastrointestinal adverse events were three to four times higher in participants who received duloxetine versus placebo. Duloxetine may be an effective treatment option for individuals with knee OA, but use of the drug is associated with a significantly higher risk of adverse events. Patient preferences and clinicians’ judgment must be considered before the initiation of duloxetine.
Abstract
About 21% of adults with osteoarthritis (OA) are diagnosed with concomitant depression in addition to chronic pain. Duloxetine, an anti-depressant medication, has been recently approved for managing Knee OA. We performed a systematic review to ascertain the efficacy and safety of duloxetine for OA. We searched MEDLINE, EMBASE, Web of Science, Google Scholar, and the Cochrane Database from inception to December 2018. Randomized clinical trials (RCTs) assessing the efficacy and/or safety of duloxetine versus placebo in OA patients were included. Data extraction and quality assessment were undertaken by two independent reviewers. Seven RCTs (n = 2,102 participants) met our inclusion criteria, and five RCTs (n = 1,713) were eligible for meta-analysis. The results of our analyses indicate that duloxetine has statistically significant, moderate benefits on pain, function, and quality of life in knee OA patients for up to 13 weeks. Reported incidences of gastrointestinal adverse events were three to four times higher in participants who received duloxetine versus placebo. Duloxetine may be an effective treatment option for individuals with knee OA, but use of the drug is associated with a significantly higher risk of adverse events. Patient preferences and clinicians’ judgment must be considered before the initiation of duloxetine.
참고문헌 (35)
- Johannes CB, "The prevalence of chronic pain in United States adults : results of an Internet-based survey", J Pain, 11, pp.1230~1239 (2010)
- Rustoen T, "Age and the experience of chronic pain : differences in health and quality of life among younger, middle-aged, and older adults", Clin J Pain, 21, pp.513~523 (2005)
- Fransen M, "The epidemiology of osteoarthritis in Asia", Int J Rheum Dis, 14, pp.113~121 (2011)
- Kim I, "Tibiofemoral osteoarthritis affects quality of life and function in elderly Koreans, with women more adversely affected than men", BMC Musculoskelet Disord, 11, pp.129~ (2010)
- Arendt-Nielsen L, "Sensitization in patients with painful knee osteoarthritis", Pain, 149, pp.573~581 (2010)
- Bajaj P, "Osteoarthritis and its association with muscle hyperalgesia : an experimental controlled study", Pain, 93, pp.107~114 (2001)
- Kidd BL, "Osteoarthritis and joint pain", Pain, 123, pp.6~9 (2006)
- Havelin J, "Central sensitization and neuropathic features of ongoing pain in a rat model of advanced osteoarthritis", J Pain, 17, pp.374~382 (2016)
- Agarwal P, "Healthcare expenditures associated with depression among individuals with osteoarthritis : post-regression linear decomposition approach", J Gen Intern Med, 30, pp.1803~1811 (2015)
- Sale JE, "The relationship between disease symptoms, life events, coping and treatment, and depression among older adults wi th osteoarthritis", J Rheumatol, 35, pp.335~342 (2008)[DOI]
- Moher D, "Preferred reporting items for systematic reviews and meta-analyses : the PRISMA statement", PLoS Med, 6, pp.e1000097~ (2009)
- "Review Manager (RevMan) (Computer program) version 5.3" (2014)[URL]
- "The Cochrane Risk of Bias Tool" (2014)[URL]
- Khawam EA, "Side effects of antidepressants : an overview", Cleve Clin J Med, 73, pp.351~353 (2006)
- "CYMBALTA (duloxetine hydrochloride) delayed-release Capsules" (2007)[URL]
- DerSimonian R, "Meta-analysis in clinical trials", Control Clin Trials, 7, pp.177~188 (1986)
- Mantel N, "Statistical aspects of the analysis of data from retrospective studies of disease", J Natl Cancer Inst, 22, pp.719~748 (1959)
- Rucker G, "Undue reliance on I(2)in assessing heterogeneity may mislead", BMC Med Res Methodol, 8, pp.79~ (2008)
- Higgins JP, "Quantifying heterogeneity in a meta-analysis", Stat Med, 21, pp.1539~1558 (2002)
- Moore RA, "Duloxetine use in chronic painful conditions : individual patient data responder analysis", Eur J Pain, 18, pp.67~75 (2014)
- Abou-Raya S, "Duloxetine for the management of pain in older adults with knee osteoarthritis : randomised placebo-controlled trial", Age Ageing, 41, pp.646~652 (2012)
- Chappell AS, "Duloxetine, a centrally acting analgesic, in the treatment of patients with osteoarthritis knee pain : a 13-week, randomized, placebo-controlled trial", Pain, 146, pp.253~260 (2009)
- Chappell AS, "A double-blind, randomized, placebo-controlled study of the efficacy and safety of duloxetine for the treatment of chronic pain due to osteoarthritis of the knee", Pain Pract, 11, pp.33~41 (2011)
- Frakes EP, "Duloxetine added to oral nonsteroidal anti-inflammatory drugs for treatment of knee pain due to osteoarthritis : results of a randomized, double-blind, placebo-controlled trial", Curr Med Res Opin, 27, pp.2361~2372 (2011)
- Uchio Y, "A randomized, double-blind, placebo-controlled Phase III trial of duloxetine in Japanese patients with knee pain due to osteoarthritis", J Pain Res, 11, pp.809~821 (2018)
- Wang G, "Efficacy and safety of duloxetine in Chinese patients with chronic pain due to osteoarthritis : a randomized, double-blind, placebo-controlled study", Osteoarthritis Cartilage, 25, pp.832~838 (2017)
- Sofat N, "The effect of pregabalin or duloxetine on arthritis pain : a clinical and mechanistic study in people with hand osteoarthritis", J Pain Res, 10, pp.2437~2449 (2017)
- Abou-Raya A, "Retracted : methotrexate in the treatment of symptomatic knee osteoarthritis : randomised placebo-controlled trial", Ann Rheum Dis, 77, pp.e46~ (2018)
- da Costa BR, "Effectiveness of non-steroidal anti-inflammatory drugs for the treatment of pain in knee and hip osteoarthritis : a network meta-analysis", Lancet, 390, pp.e21~e33 (2017)
- Wang ZY, "Efficacy and safety of duloxetine on osteoarthritis knee pain : a meta-analysis of randomized controlled trials", Pain Med, 16, pp.1373~1385 (2015)
- Ananias J, "Is duloxetine an alternative in the treatment of osteoarthritis?", Medwave, 17, pp.e7063~ (2017)
- Cipriani A, "Duloxetine versus other anti-depressive agents for depression", Cochrane Database Syst Rev, 10, pp.CD006533~ (2012)
- Cipriani A, "Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder : a systematic review and network meta-analysis", Lancet, 391, pp.1357~1366 (2018)
- Sostres C, "Nonsteroidal anti-inflammatory drugs and upper and lower gastrointestinal mucosal damage", Arthritis Res Ther, (15 Suppl 3), pp.S3~ (2013)
- Wielage RC, "Cost effectiveness of duloxetine for osteoarthritis : a Quebec societal perspective", Arthritis Care Res(Hoboken), 66, pp.702~708 (2014)