Short-term duloxetine improves pain and joint function in Osteoarthritis

Osteoarthritis is a painful and debilitating disease of Joints. According to a new meta-analysis in patients with osteoarthritis (OA), short-term duloxetine (10-14 weeks) may be a safe and effective treatment option to improve pain and functional outcomes. Findings warrant further studies to determine the optimal dosage of duloxetine and examine its long-term efficacy and safety in patients with OA. The study has been published in the Journal Medicine.

Previous clinical trials indicated that duloxetine may be effective in the treatment of osteoarthritis (OA) pain. This meta-analysis was conducted to evaluate short term analgesic effect and safety of duloxetine in the treatment of osteoarthritis.

The researchers searched electronic databases in February 2019, including PUBMED, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Web of Science and included 5 randomised controlled trials (n=2059) in the meta-analysis that compared the effects of duloxetine (20-120 mg/day for 10-14 weeks) vs placebo for pain relief and safety outcomes.

• Duloxetine vs placebo group showed significantly:
  
  
  
  • higher reduction in pain intensity (mean difference [MD], −0.77; 95% CI, −0.95 to −0.59);
  
  
  • higher rates of both 30% (risk ratio [RR], 1.42; 95% CI, 1.30-1.56) and 50% (RR, 1.62; 95% CI, 1.30-2.02) reduction in pain severity; and
  
  
  • lower mean Patient Global Improvement-Inventory score (MD, −0.48; 95% CI, −0.59 to −0.37; P<.00001 for all).
  
  
  
  


• From the pooled results of the Western Ontario and McMaster Universities score, duloxetine vs placebo group had significant improvement in:
  
  
  
  • overall satisfaction (MD, −5.43; 95% CI, −6.87 to −3.99; P<.00001);
  
  
  • pain severity (MD, −1.63; 95% CI, −2.63 to −0.63; P=.001);
  
  
  • physical function (MD, −4.22; 95% CI, −6.17 to −2.28; P<.0001); and
  
  
  • joint stiffness (MD, −0.58; 95% CI, −0.75 to −0.41; P<.00001).
  
  
  
  


• The incidence of treatment-emergent adverse events (RR, 1.32; 95% CI, 1.20-1.44; P<.00001) and discontinuation (RR, 1.88; 95% CI, 1.29-2.75; P=.001) was significantly higher in duloxetine vs placebo group.


• No significant difference was observed in the incidence of severe adverse events between 2 groups (RR, 0.84; 95% CI, 0.37-1.90; P=.68).

The limitations of the study are the inclusion of a small number of studies and that the treatment strategies and baseline characteristics of patients were not consistent in studies.

The researchers concluded that Duloxetine was an effective and safe choice to improve pain and functional outcome in OA patients. However, further studies are still needed to find out the optimal dosage for OA and examine its long-term efficacy and safety.

Gao SH, Huo JB, Pan QM, Li XW, Chen HY, Huang JH. The short-term effect and safety of duloxetine in osteoarthritis: A systematic review and meta-analysis. 2019;98(44):e17541. DOI: 10.1097/MD.0000000000017541. PMID: 31689755