Targeting Nerve Growth Factor, a new option for treatment of osteoarthritis: A Network meta-analysis of comparative efficacy and safety with traditional drugs

BACKGROUND: Osteoarthritis (OA) is the most common joint disease and leading cause of pain and disability in the elderly population. Most guidelines recommend the use non-steroidal anti-inflammatory drugs (NSAIDs) and opioids for the non-operative treatment of OA. Monoclonal NGF antibodies are potential for pain relief and function improvement of OA. We conducted this network meta-analysis to comprehensively compare the efficacy and safety of monoclonal NGF antibodies with NSAIDs and opioids for OA. METHODS: Relevant studies, published up to January 2020, were included from PubMed, CKNI and Web of Science databases. Bayesian network and conventional meta-analyses were conducted. Pain relief, function improvement and risk of adverse effects (AEs) were assessed. RESULTS: 38 articles, comprising 41 trials (20489 patients with OA) were included. Overall, Anti-NGF was the most efficacious drug for pain relief (SMD compared with placebo 4.25, 95% CIs [2.87 to 5.63], SUCRA=93.7%) and (SMD 4.90, 95% CIs [3.46 to 6.33], SUCRA=98.3%). Although Anti-NGF was associated with higher risk of peripheral sensation abnormality (paresthesia and pruritus), it was not associated with higher withdrawal rates due to AEs and ohter AEs. CONCLUSIONS: The results show that monoclonal NGF antibodies significantly relieve pain due to OA and improve function, compared to selective cox-2 inhibitions, NSAIDs, and opioids. The monoclonal NGF antibodies are not associated with severe AEs. However, there is need to conduct more studies to confirm the findings of this study.