A&R:度洛西汀对髋关节或膝关节骨性关节炎慢性疼痛患者无附加价值:一项集群随机试验

2022-05-20 MedSci原创 MedSci原创

该研究发现与单独的常规护理相比,度洛西汀添加到常规护理中对慢性膝关节或髋关节慢性骨关节炎OA疼痛患者没有影响。

   目的:评估度洛西汀在慢性骨关节炎(OA)疼痛患者中除常规护理外的有效性。成本效益分析以及存在集中性疼痛症状是否会改变对度洛西汀的反应是次要目标。

   方法:研究团队进行了一项开放标签、整群随机试验。纳入对对乙酰氨基酚和非甾体抗炎药反应不足的慢性髋关节或膝关节OA疼痛患者。随机化发生在整体实践水平,患者接受度洛西汀(60 mg/天)和常规护理,或者单独常规护理。存在集中性疼痛的定义是修改后的PainDETECT问卷评分>12主要结局指标是治疗开始后3个月时的西安大略和麦克马斯特大学骨关节炎指数(WOMAC)疼痛评分(0-20 级)。该研究的目标是检测临床相关效应为1.9分(效应大小为0.4)的组间差异。使用具有重复测量的线性混合模型来分析数据。

   结果:总共纳入133名患者,其中132名患者被随机分入两个治疗组。共有66名患者(31家诊所)被随机分入接受常规护理和度洛西汀治疗组,另外66名患者(35家诊所)被随机分入接受单独常规护理组。研究发现在3个月(调整后的差异–0.58 [95% 置信区间(95% CI)1.80, 0.63])或12个月时(调整后的差异–0.26 [95% CI1.86, 1.34])组间的WOMAC疼痛评分没有差异。在有集中疼痛症状的患者亚组中,还发现度洛西汀与单独的常规治疗相比没有效果(调整后的差异–0.32 [95% CI2.32, 1.67]

   结论:该研究发现与单独的常规护理相比,度洛西汀添加到常规护理中对慢性膝关节或髋关节OA疼痛患者没有影响。应进行另一项包括集中疼痛症状患者的试验以验证该研究的结果。

 

出处:van den Driest, J.J., Schiphof, D., Koffeman, A.R., Koopmanschap, M.A., Bindels, P.J.E. and Bierma-Zeinstra, S.M.A. (2022), No Added Value of Duloxetine in Patients With Chronic Pain due to Hip or Knee Osteoarthritis: A Cluster-Randomized Trial. Arthritis Rheumatol, 74: 818-828. https://doi.org/10.1002/art.42040

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    2022-05-20 lmm397
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