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Efficacy and Safety of Intra-Articular Cell-Based Therapy for Osteoarthritis: Systematic Review and Network
Wei Ding1, Yong-Qing Xu2, Ying Zhang2
1Medical College, Yunnan University of Business Management, Kunming, Yunnan, People's Repuplic of China.
Objective:
Osteoarthritis (OA) is a chronic joint disease characterized by degeneration of articular cartilage and secondary osteogenesis. Cell-based agents, such as mesenchymal stem cells, have turned into the most extensively explored new therapeutic agents for OA. However, evidence-based research is still lacking.
Methods:
We searched public databases up to February 2020 and only included randomized controlled trials. The outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Knee Injury and Osteoarthritis Outcome Score (KOOS), the visual analogue scale (VAS) score, and serious adverse events (SAEs). A network meta-analysis was also performed in this work.
Results:
We included 13 studies in the meta-analysis. The effect size showed that cell-based therapy did not significantly reduce the WOMAC score at the 6-month follow-up (standard mean difference [SMD] -3.6; 95% confidence interval [CI] -0.90 to 0.18; P = 0.1928). However, cell-based therapy significantly improved the KOOS at the 12-month follow-up (SMD 0.68; 95% CI 0.07-1.30; P = 0.0288) and relieved pain (SMD -1.05; 95% CI -1.46 to -0.64; P < 0.0001). The findings also indicated that high-dosage adipose-derived mesenchymal stem cells (ADMSCs) may be more advantageous in terms of long-term effects.
Conclusions:
Cell-based therapy had a better effect on KOOS improvement and pain relief without safety concerns. However, cell-based therapy did not show a benefit in terms of the WOMAC. Allogeneic cells might have advantages compared to controls in the WOMAC and KOOS scores. The long-term effect of high-dose ADMSC treatment for OA is worthy of further study.
Insights
Cell-based therapy shows promise for osteoarthritis (OA) by improving knee function and pain relief, though not consistently reducing WOMAC scores. High-dose adipose-derived mesenchymal stem cells (ADMSCs) may offer long-term benefits for OA patients.
Area of Science:
- Orthopedics and Sports Medicine
- Regenerative Medicine
- Rheumatology
Background:
- Osteoarthritis (OA) is a degenerative joint disease impacting articular cartilage and bone.
- Cell-based therapies, particularly mesenchymal stem cells, are emerging as potential treatments for OA.
- Robust evidence supporting the efficacy of cell-based therapies for OA remains limited.
Purpose of the Study:
- To systematically evaluate the efficacy and safety of cell-based therapies for osteoarthritis.
- To synthesize findings from randomized controlled trials (RCTs) using meta-analysis.
- To identify specific cell types or dosages that may offer superior outcomes.
Main Methods:
- A comprehensive search of public databases was conducted up to February 2020.
- Only randomized controlled trials (RCTs) investigating cell-based therapies for OA were included.
- Network meta-analysis was performed, assessing outcomes like WOMAC, KOOS, VAS pain scores, and serious adverse events (SAEs).
Main Results:
- Cell-based therapy did not significantly improve WOMAC scores at 6 months (SMD -0.36; P=0.1928).
- Significant improvements were observed in KOOS scores at 12 months (SMD 0.68; P=0.0288) and pain relief (SMD -1.05; P<0.0001).
- High-dose adipose-derived mesenchymal stem cells (ADMSCs) showed potential for long-term benefits.
Conclusions:
- Cell-based therapy demonstrates efficacy in improving knee function (KOOS) and pain relief in OA patients without significant safety concerns.
- The benefit of cell-based therapy on WOMAC scores was not statistically significant.
- Allogeneic cells may offer advantages over controls, and further research into high-dose ADMSC treatments for OA is warranted.
