Background & Aims
Current treatment guidelines do not consider patient sex as a relevant factor during the decision-making process, despite evidence showing important differences in how OA affects people of each sex. Studies have shown that women with OA report higher levels of pain, greater serum CRP levels, and higher levels of functional impairment compared to their male counterparts . Additionally, there is a growing body of research that points to differences in the perception and level of pain between the sexes, with females usually reporting higher levels of pain than males in the clinical setting.(1) No study has specifically addressed the existence of sex-specific differences in the efficacy of systemic pharmacological treatments for symptomatic knee OA. The objective of this systematic review is therefore to assess available evidence from clinical trials to evaluate the role of sex as a potential effect modifier in the response to systemic therapy in the setting of knee OA.
Methods
A systematic review, guided by Cochrane methods, sourced studies from Medline, Cochrane Library, Embase, and CINAHL Plus with Full Text as of October 10, 2022. Eligible studies were double-blind RCTs evaluating systemic pharmacological treatments for knee osteoarthritis in adults, with minimum 30-day treatment duration, reporting sex-specific results or mentioning sex subgroup analysis for analgesic efficacy. Two reviewers screened studies for eligibility using Rayyan. Automation tools were not used. Data extraction was performed using a standardized template. Each paper was independently assessed by reviewers for data collection and extraction. The risk of bias was assessed using the Cochrane Risk of Bias tool version 2 (RoB 2).
Results
Of 4574 citations screened, 9 studies (5201 participants) met inclusion criteria, analyzing drugs including duloxetine, etoricoxib, tapentadol, naproxcinod, lutikizumab, and rofecoxib. Only one study reported sex-specific results. Review findings suggested no significant sex-based differences in treatment efficacy, however, data were limited due to a lack of sex-specific reporting or inclusion of sex in subgroup analyses.
Conclusions
Available evidence is insufficient to evaluate differences in the analgesic response to pharmacological treatments of knee osteoarthritis between males and females. Current studies are limited by infrequent reporting of results by sex, small sample sizes, and insufficient statistical power. Our findings emphasize the need for more comprehensive research incorporating sex-stratified reporting and analysis to allow for future meta-analyses to determine whether sex-based differences exist.
References
1. Fillingim RB, King CD, Ribeiro-Dasilva MC, Rahim-Williams B, Riley JL. Sex, Gender, and Pain: A Review of Recent Clinical and Experimental Findings. The Journal of Pain. 2009;10(5):447-85.
Presenting Author
Thomas Schnitzer
Poster Authors
Thomas Schnitzer
MD, PhD
Northwestern University Feinberg School of Medicine
Lead Author
Santiago Espinosa-Salas MD
Northwestern University Feinberg School of Medicine
Lead Author
Leila Bagherzadeh MD
Northwestern University Feinberg School of Medicine
Lead Author
Q. Eileen Wafford
Northwestern University Feinberg School of Medicine
Lead Author
Graeme Witte
Northwestern University Feinberg School of Medicine
Lead Author
Topics
- Gender/Sex Differences