PMID- 35611671
OWN - NLM
STAT- MEDLINE
DCOM- 20221118
LR  - 20221118
IS  - 1941-9260 (Electronic)
IS  - 0032-5481 (Linking)
VI  - 134
IP  - 8
DP  - 2022 Nov
TI  - Comparative risk-benefit profiles of weak opioids in the treatment of 
      osteoarthritis: a network meta-analysis of randomized controlled trials.
PG  - 784-794
LID - 10.1080/00325481.2022.2080360 [doi]
AB  - BACKGROUND: Despite their poor tolerance, weak opioids are still the most 
      commonly-prescribed medicine for osteoarthritis (OA)-related pain. The objective 
      of this network meta-analysis was to comparatively examine the efficacy and 
      safety of weak opioids in OA treatment. METHODS: Databases including PubMed, 
      Embase, Cochrane Library and Web of Science were searched from inception to 4 
      April 2022 to retrieve randomized controlled trials (RCTs) comparing weak opioids 
      with placebo or between one another in OA patients. Bayesian network 
      meta-analysis was performed on the following outcomes of interest, namely the 
      change-from-baseline score in pain relief, gastrointestinal (GI) adverse events 
      (AEs), central nervous system (CNS) AEs, and total number of AEs (i.e. the number 
      of subjects experiencing any AE for at least once) during follow-up. The surface 
      under the cumulative ranking curve (SUCRA) was used to rank the effectiveness of 
      each treatment and identify the best treatment. RESULTS: A total of 14 RCTs 
      invoving four types of weak opioids were included in this meta-analysis. Compared 
      to placebo, tramadol (standardized mean difference [SMD] = -0.34, 95% credible 
      interval [CrI]: -0.53 to -0.18) and codeine (SMD = -0.39, 95% CrI: -0.79 to 
      -0.04) were effective for pain relief, but involved a higher risk of GI AEs, CNS 
      AEs and total number of AEs. Dextropropoxyphene demonstrated a significantly 
      lower risk of GI AEs (OR = 0.28, 95%CrI: 0.17 to 0.51), CNS AEs (OR = 0.29, 
      95%CrI: 0.11 to 0.78) and total number of AEs (OR = 0.35, 95%CrI: 0.15 to 0.82) 
      compared to codeine. Dihydrocodeine had a better safety profile in CNS AEs 
      (SUCRA = 64.8%) and total number of AEs (SUCRA = 66.6%). CONCLUSIONS: The results 
      of the present study confirmed that tramadol and codeine were effective drugs for 
      the treatment of OA, but involved considerable safety issues. Dextropropoxyphene 
      and dihydrocodeine exhibited a relatively good safety profile but their efficacy 
      still warrant further investigation.
FAU - Li, Wei
AU  - Li W
AUID- ORCID: 0000-0002-8891-9067
AD  - Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 
      Hunan, China.
FAU - He, Hongyi
AU  - He H
AUID- ORCID: 0000-0002-5883-5399
AD  - Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 
      Hunan, China.
FAU - Yang, Zidan
AU  - Yang Z
AD  - Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China.
FAU - Wu, Ziying
AU  - Wu Z
AUID- ORCID: 0000-0002-5127-5253
AD  - Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 
      Hunan, China.
FAU - Xie, Dongxing
AU  - Xie D
AD  - Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 
      Hunan, China.
AD  - Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China.
AD  - Hunan Engineering Research Center for Osteoarthritis, Changsha, Hunan, China.
AD  - National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, 
      Central South University, Changsha, Hunan, China.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
DEP - 20220607
PL  - England
TA  - Postgrad Med
JT  - Postgraduate medicine
JID - 0401147
RN  - 0 (Analgesics, Opioid)
RN  - 39J1LGJ30J (Tramadol)
RN  - S2F83W92TK (Dextropropoxyphene)
RN  - UX6OWY2V7J (Codeine)
SB  - IM
MH  - Humans
MH  - Network Meta-Analysis
MH  - Analgesics, Opioid/adverse effects
MH  - *Tramadol/adverse effects
MH  - Dextropropoxyphene/therapeutic use
MH  - Randomized Controlled Trials as Topic
MH  - *Osteoarthritis/drug therapy
MH  - Codeine/therapeutic use
MH  - Pain
OTO - NOTNLM
OT  - Weak opioids
OT  - network meta-analysis
OT  - osteoarthritis
EDAT- 2022/05/26 06:00
MHDA- 2022/11/19 06:00
CRDT- 2022/05/25 04:43
PHST- 2022/05/26 06:00 [pubmed]
PHST- 2022/11/19 06:00 [medline]
PHST- 2022/05/25 04:43 [entrez]
AID - 10.1080/00325481.2022.2080360 [doi]
PST - ppublish
SO  - Postgrad Med. 2022 Nov;134(8):784-794. doi: 10.1080/00325481.2022.2080360. Epub 
      2022 Jun 7.