The Effectiveness of Duloxetine for Knee Osteoarthritis: An Overview of Systematic Reviews

Abstract

Background: Knee osteoarthritis (KOA) has become a public health problem. Several systematic reviews (SRs) have reported that duloxetine may be an effective treatment for improving pain and depressive symptoms in patients with KOA.Aim: To evaluate the available results and provide scientific evidence for the efficacy and safety of duloxetine for KOA.Methods: A comprehensive search strategy was conducted across eight databases from inception to 31 December 2021. Two researchers independently selected eligible studies, collected data and evaluated those included SRs’ quality. For assessing methodological quality, the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR 2) was employed. Risk of Bias in Systematic Reviews (ROBIS) was used to assess the risk of bias. Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) was utilized for assessing reporting quality. In addition, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to determine primary outcome indicators’ evidence quality.Results: Totally 6 SRs were contained in this overview. After assessment based on AMSTAR 2, ROBIS, and PRISMA, unsatisfactory results in terms of methodological quality, risk of bias as well as reporting quality, were obtained. Limitations included a search of grey literature, the reasons for selecting the study type, an excluded study list and the specific reasons, reporting bias assessment, and reporting of potential sources of conflict of interest. According to the GRADE results, the evidence quality was high in 0, moderate in 5, low in 19, and very low in 36. Limitations were the most commonly downgraded factor, followed by publication bias and inconsistency.Conclusion: Duloxetine may be an effective treatment for improving pain and depressive symptoms in KOA patients with acceptable adverse events. However, due to the low quality of the available evidence, the original study design and the quality of evidence from SRs should be further improved, so as to provide strong scientific evidence for definitive conclusions.Systematic Review Registration: PROSPERO; (http://www.crd.york.ac.uk/PROSPERO/), identifier (CRD42021289823).

Research of the analgesic effects and central nervous system impact of electroacupuncture therapy in rats with knee osteoarthritis

“…This result indicated that EA could strengthen the acupuncture intensity and that the analgesic effect was more obvious. Duloxetine is a serotonin and NE reuptake inhibitor, which has effects of anti-depression, anti-anxiety, and inhibition of central pain [ 26 ]. Studies have shown that duloxetine can effectively relieve the pain caused by musculoskeletal system diseases and the symptoms of KOA, and no serious adverse reactions have been observed [ 27 ].…”

The Efficacy of Electroacupuncture in the Treatment of Knee Osteoarthritis: A Systematic Review and Meta‐Analysis

“…Since less than 20% of clinical guidelines do not consider the interests and preferences of patients, [ 74 ] we recommend that practitioners should choose proper therapies with less adverse effects and similar therapeutic efficacy after considering the interests and preferences of patients. A recent overview stated that six systemic reviews proved that duloxetine was superior to the placebo in reducing pain in KOA patients although the quality of these reviews was low, [ 75 ] but in the included studies of our meta‐analysis, duloxetine was not used. An RCT from United States stated that duloxetine could significantly reduce pain and improve knee function.…”

The efficacy and safety of duloxetine for the treatment of patients after TKA or THA: A systematic review and meta-analysis

“…Duloxetine is an effective selective SNRI primarily used to treat depression and has been shown to have analgesic effects in patients with chronic musculoskeletal pain and OA in some meta-analysis. [22,23,[33][34][35][36] The meta-analysis by Branton et al [21] indicate that adding duloxetine to a multimodal analgesia regimen significantly reduces total postoperative opioid consumption and pain without significant adverse effects in the orthopedic surgical setting, another recent meta-analysis by Zorrilla-vaca et al [37] also found similarly improved pain scores with the use of perioperative duloxetine. However, its effect on postoperative pain relief and safety after TKA or THA are still controversial.…”

“…[ 12 , 15 , 19 , 20 ] Some recent meta-analysis also shows that duloxetine has a positive effect on pain in OA patients. [ 21 – 23 ] However, some others [ 24 ] found that the post TJA pain of patients with ambulation, flexion, and at rest did not differ between groups throughout postoperative weeks 1 to 6, and it is unknown whether this beneficial effect remains in long-term follow-up. Therefore, the peri-TJA use of duloxetine for postoperative pain relief still remains controversial.…”