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静脉注射唑来膦酸不能降低膝骨关节炎骨髓病变
2020-05-01 13:40

本期文章:《美国医学会杂志》:Vol 323 No 15

澳大利亚塔斯马尼亚大学Graeme Jones研究团队近期取得新进展。他们探讨了静脉注射唑来膦酸对膝骨关节炎骨髓病变患者胫股软骨体积的影响。该成果于2020年4月21日发表在《美国医学会杂志》上。

一项原理论证的研究表明,静脉注射唑来膦酸可以减轻膝骨关节炎患者的膝关节疼痛和骨髓病变的大小,但尚缺乏大型试验数据支持。

为了探讨静脉注射唑来膦酸对有症状的膝骨关节炎和骨髓病变患者膝关节软骨体积损失的影响,研究组在澳大利亚的4个医疗点进行了一项为期24个月、多中心,双盲、安慰剂对照、随机临床试验。

2013年11月至2015年9月,研究组招募了223名50岁以上有症状的膝骨关节炎和软骨下骨髓病变患者,均经核磁共振成像(MRI)确诊。将其随机分组,在基线和12个月时,113例患者静脉滴注唑来磷酸生理盐水,110例静脉滴注安慰剂生理盐水。

223名参与者的平均年龄为62.0岁,女性占52%。共有190名完成了试验。唑来膦酸组和安慰剂组患者在24个月内胫股软骨体积分别损失了878 mm3和919 mm3,组间差异无统计学意义。在24个月内,两组间膝痛变化、膝骨关节炎指数、骨髓病变大小等次要指标均无显著性差异。唑来磷酸组的不良事件发生率为96%,显著高于安慰剂组(83%)。

总之,对于有症状的膝骨关节炎和骨髓病变患者,与安慰剂相比,每年静脉注射一次唑来膦酸并不能显著降低24个月内的软骨体积损失,不建议临床推广。

附:英文原文

Title: Effect of Intravenous Zoledronic Acid on Tibiofemoral Cartilage Volume Among Patients With Knee Osteoarthritis With Bone Marrow Lesions: A Randomized Clinical Trial

Author: Guoqi Cai, Dawn Aitken, Laura L. Laslett, Jean-Pierre Pelletier, Johanne Martel-Pelletier, Catherine Hill, Lyn March, Anita E. Wluka, Yuanyuan Wang, Benny Antony, Leigh Blizzard, Tania Winzenberg, Flavia Cicuttini, Graeme Jones

Issue&Volume: 2020/04/21

Abstract: Importance  A proof-of-principle study suggested that intravenous zoledronic acid may reduce knee pain and the size of bone marrow lesions in people with knee osteoarthritis, but data from large trials are lacking.

Objective  To determine the effects of intravenous zoledronic acid on knee cartilage volume loss in patients with symptomatic knee osteoarthritis and bone marrow lesions.

Design, Setting, and Participants  A 24-month multicenter, double-blind placebo-controlled randomized clinical trial conducted at 4 sites in Australia (1 research center and 3 hospitals). Adults aged 50 years or older with symptomatic knee osteoarthritis and subchondral bone marrow lesions detected by magnetic resonance imaging (MRI) were enrolled from November 2013 through September 2015. The final date of follow-up was October 9, 2017.

Interventions  Intravenous infusion with either 5 mg of zoledronic acid in a 100-mL saline solution (n=113) or a placebo saline solution (n=110) at baseline and 12 months.

Main Outcomes and Measures  The primary outcome was absolute change in tibiofemoral cartilage volume assessed using MRI over 24 months (the minimum clinically important difference [MCID] has not been established). Three prespecified secondary outcomes were change in knee pain assessed by a visual analog scale (0 [no pain] to 100 [unbearable pain]; MCID, 15) and the Western Ontario and McMaster Universities Osteoarthritis Index (0 [no pain] to 500 [unbearable pain]; MCID, 75) over 3, 6, 12, 18, and 24 months and change in bone marrow lesion size over 6 and 24 months (the MCID has not been established).

Results  Of 223 participants enrolled (mean age, 62.0 years [SD, 8.0 years]; 52% were female), 190 (85%) completed the trial. Change in tibiofemoral cartilage volume was not significantly different between the zoledronic acid group and the placebo group over 24 months (878 mm3 vs 919 mm3; between-group difference, 41 mm3 [95% CI, 79 to 161 mm3]; P=.50). No significant between-group differences were found for any of the prespecified secondary outcomes, including changes in knee pain assessed by a visual analog scale (11.5 in the zoledronic acid group vs 16.8 in the placebo group; between-group difference, 5.2 [95% CI, 2.3 to 12.8]; P=.17), changes in knee pain assessed by the Western Ontario and McMaster Universities Osteoarthritis Index (37.5 vs 58.0, respectively; between-group difference, 20.5 [95% CI, 11.2 to 52.2]; P=.21), and changes in bone marrow lesion size (33 mm2 vs 6 mm2; between-group difference, 27 mm2 [95% CI, 127 to 73 mm2]; P=.60) over 24 months. Adverse events were more common with zoledronic acid than with placebo (96% vs 83%, respectively) and consisted mainly of acute reactions (defined as symptoms within 3 days of administration of infusion; 87% vs 56%).

Conclusions and Relevance  Among patients with symptomatic knee osteoarthritis and bone marrow lesions, yearly zoledronic acid infusions, compared with placebo, did not significantly reduce cartilage volume loss over 24 months. These findings do not support the use of zoledronic acid in the treatment of knee osteoarthritis.

DOI: 10.1001/jama.2020.2938

Source: https://jamanetwork.com/journals/jama/article-abstract/2764707

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