A Novel Monoclonal Management of Geriatric Osteoarthritis: Network Meta-Analysis of Comparative Efficacy and Safety of Tanezumab against Oral NSAIDs
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Abstract
Introduction: Osteoarthritis (OA) affects approximately 250 million people worldwide and significantly causes pain and disability. Although NSAIDs are the first-line therapy, their use in geriatrics should be cautiously prescribed because of comorbidities, polypharmacy, and adverse events. Tanezumab is a humanized monoclonal IgG2 antibody that blocks NGF from activating trkA receptors on nociceptive neurons. Recent studies have shown Tanezumab as a promising candidate for enhanced clinical effects in geriatrics. However, previous meta-analyses lacked specificity for different doses of Tanezumab and did not confirm the comparison with NSAIDs.
Objective: This study aims to compare the efficacy and safety of Tanezumab with oral NSAIDs in geriatric osteoarthritis treatment.
Method: This study was conducted using the Preferred Reporting Item for Systematic Review and Meta-analysis (PRISMA). We systematically searched PubMed, ScienceDirect, and Google Scholar until April 4, 2023. The PRISMA method was done to evaluate potential bias. We performed a network meta-analysis using a random effects model that compared three doses of Tanezumab (2.5mg, 5mg, and 10mg) with NSAIDs. We measured heterogeneity using I2 and publication bias with a funnel plot.
Result: Twelve studies with a total of 7031 patients, which were screened with low risk of bias. The results showed that Tanezumab (5mg and 10mg) was the most effective for pain relief (WOMAC Pain; SMD -1.09; 95% CI -2.02 to -0.15; p = 0.002), increasing physical function (WOMAC Physical Function; SMD -5.47; 95% CI -8.71 to -2.24; p = 0.0009), and improving general health (PGA; SMD -3.83; 95% CI -6.94 to -0.72; p = 0.02). Moreover, Tanezumab was shown to be safe and associated with fewer adverse effects than NSAIDs
Conclusion: Tanezumab shows more efficacy on reducing pain, improving function, and shows less adverse effects in comparison to NSAIDs. Thus, recommended to be used for patients with inadequate reaction to therapy or comorbidities.
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