关节内肉毒杆菌毒素A型(BTA)已被证明对疼痛性膝骨关节炎(KOA)有效,而关节内BTA与皮质类固醇和透明质酸(HA)相比的疗效和安全性仍然未知。进行了荟萃分析以进行比较。在Medline(PubMed)进行了搜索,中心(Cochrane图书馆),Embase(Ovid),WebofScience,万方,和CNKI文献找到直接比较关节内BTA和关节内皮质类固醇或HA对疼痛性KOA患者的疗效和安全性的随机对照试验(RCT)。CochraneQ检验和I2估计用于评估研究之间的异质性。在纳入异质性之后,随机效应模型用于数据汇集.总的来说,纳入了6项RCTs,涉及348名KOA成人.关节内BTA显示出与皮质类固醇相似的疗效,疼痛视觉模拟量表(VAS:-0.35[-0.97,0.28])的变化证明,西安大略省麦克马斯特大学关节炎总指数(WOMAC:0.28[-4.13,4.69]),和WOMAC疼痛(0.64[-0.42,1.70]),刚度(-0.02[-0.54,0.50]),和功能(0.00[-2.99,3.00])。关节内BTA在改善疼痛VAS(-1.31[-1.97,-0.64])和WOMAC(-4.81[-8.73,-0.89])方面比HA更有效,而对WOMAC对膝关节刚度(-1.01[-4.43,2.41])和膝关节功能(-1.86[-6.71,2.99])的影响组间相似。未报告严重不良事件。来自试点随机对照试验的证据表明,关节内BTA可能赋予KOA与皮质类固醇相似的疗效,而BTA在改善膝关节疼痛方面可能优于HA。
Intraarticular botulinum toxin type A (BTA) has been shown to be effective for painful knee osteoarthritis (KOA), while the efficacy and safety of
intraarticular BTA compared to corticosteroid and hyaluronic acid (HA) remains unknown. A meta-analysis was performed to compare. A search was conducted in Medline (PubMed), CENTER (Cochrane Library), Embase (Ovid), Web of Science, Wanfang, and CNKI to find head-to-head randomized controlled trials (RCTs) directly compare the efficacy and safety between intraarticular BTA and
intraarticular corticosteroid or HA for patients with painful KOA. The Cochrane Q test and estimation of I2 were used to assess heterogeneity among studies. After incorporating heterogeneity, a random-effects model was employed for data pooling. Overall, six RCTs involving 348 adults with KOA were included.
Intraarticular BTA showed similar efficacy with corticosteroid as evidenced by the changes of pain visual analog scale (VAS: -0.35 [-0.97, 0.28]), total Western Ontario McMaster Universities Arthritis Index (WOMAC: 0.28 [-4.13, 4.69]), and WOMAC for pain (0.64 [-0.42, 1.70]), stiffness (-0.02 [-0.54, 0.50]), and function (0.00 [-2.99, 3.00]).
Intraarticular BTA was shown to be more effective than HA in improving pain VAS (-1.31 [-1.97, -0.64]) and WOMAC for pain (-4.81 [-8.73, -0.89]), while the influence on WOMAC for knee stiffness (-1.01 [-4.43, 2.41]) and knee function (-1.86 [-6.71, 2.99]) were similar between groups. No serious adverse events were reported. Evidence from pilot RCTs suggests that intraarticular BTA may confer similar efficacy to corticosteroid for KOA, while BTA may be superior to HA for improving knee pain.