Background & Aims
Osteoarthritis (OA) is a widespread and commonly occurring chronic joint condition that leads to pain, reduced mobility, and impaired functionality. The knee is most affected.Pain stands as the predominant indication and frequently persists over time, resulting in notable negative health impacts and reduced quality of life. Duloxetine exhibits its effects primarily within the central nervous system, functioning as a discerning and relatively balanced inhibitor of serotonin and norepinephrine reuptake.In the realm of research, previous meta-analyses have delved into the effectiveness and safety of duloxetine for knee OA or chronic low back pain, yet they encompassed a limited array of studies. This updated review till 2023 aims to unearth a substantial body of evidence that advocates for the essential role of duloxetine in the treatment of OA, thereby enriching our understanding of its necessity in this context.
Methods
We conducted a comprehensive search for pertinent randomized controlled trials (RCTs) across multiple databases, including PubMed, Embase, Scopus, Cochrane Central Register of Controlled Trials,ClinicalTrials.gov and Google scholar. These selected RCTs aimed to assess the effectiveness and safety of duloxetine versus a placebo in the management of osteoarthritis (OA). We computed the mean difference (MD) for continuous outcome measures and calculated the risk ratio (RR) for dichotomous outcome measures.
Results
Data from 10 RCT including 2294 participants comparing duloxetine and placebo were pooled. Duloxetine showed improvement in BPI-S (Brief Pain Inventory-Severity), BPI-I (Brief Pain Inventory-Interference), WOMAC (Western Ontario and McMaster Universities Arthritis Index) pain sub scale scores, physical function,SF 36 (Short Form) and patients global impressions scores. Duloxetine resulted in higher number of treatment emergent adverse events and discontinuations. However duloxetine was no different from placebo in improving stiffness and in terms of incidence of serious adverse effects.
Conclusions
Duloxetine demonstrates effectiveness in addressing chronic pain and mitigating the decline in physical function associated with knee osteoarthritis (OA), while maintaining a reasonable level of tolerable adverse events. However, it does not offer a distinct advantage in alleviating joint stiffness.
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