THU0468 EFFICACY AND SAFETY OF INTRA-ARTICULAR THERAPIES IN RHEUMATIC AND MUSCULOSKELETAL DISEASES: AN OVERVIEW OF SYSTEMATIC REVIEWS INFORMING THE 2020 EULAR RECOMMENDATIONS FOR INTRA-ARTICULAR THERAPIES INCLUDING SYNOVIORTHESIS
Authors: S. C. Rodriguez-García, R. Castellanos-Moreira, J. Uson Jaeger, E. Naredo, L. Carmona
Journal: Annals of the Rheumatic Diseases (2020)

Background: Intra-articular therapy (IAT) is subject to wide variability and there are gaps in the evidence on its efficacy and safety. Objectives: To assess the efficacy and safety of frequently used IATs to inform a EULAR Taskforce. Methods: We performed an overview of systematic reviews (SR) of randomised clinical trials (RCT) assessing efficacy and safety of IAT in adults with RMDs. MEDLINE was searched until January 2019. SRs were assessed with the AMSTAR-2 tool. Critically low-confidence SRs were excluded. Results: Of 159 articles identified, 42 were reviewed in detail and 15 met the inclusion criteria (146 RCTs). The populations included were mainly knee osteoarthritis (OA) in 10 SRs, rheumatoid arthritis (RA) in 3, hip and temporo-mandibular (TM) OA and shoulder adhesive capsulitis in 1 SR each. In knee OA, Hyaluronic Acid (HA) showed a modest benefit over placebo for pain and function but with unclear clinical significance in some studies. Platelet rich plasma (PRP) showed a small effect over HA only for function. Mesenchymal stem cells (MSC) performed better than PRP and HA for some outcomes, however, in studies with high risk of bias. Intra-articular Glucocorticoids (GC) were better than placebo (PBO) for pain and function. More adverse events (AE) were seen in the PRP group compared with HA and for HA compared with PBO including serious AE each in 1 SR on knee OA. Results for other included diseases are shown in table 1. Table 1. Summary of SR. P: population; C: comparation; H: High, M: Moderate; L: Low confidence; MA: meta-analysis; SOC: standard of care; PRO: patient reported outcomes; ROM: range of motion; MPA: methylprednisolone acetate; TA/TH: triamcinolone acetonide/ hexacetonide; MW: molecular weight; YR: Yttrium synoviorthesis *Same SR assessed knee arthritis in OA and RA separately SR P C AMSTAR2 Efficacy Safety Newberry knee OA HA vs PBO; HA; Lavage H MA . HA better than PBO in function in older patients (small effect). No diff in AE Juni GC vs Sham; PBO; SOC H MA . GC better in pain and function until 6w. No diff at 12-24w. No diff in AE Pas MSC vs PBO; PRP; HA M No MA . MSC better in pain, PRO, MRI, etc High risk of bias. No diff in AE Trojian HA vs PBO; GC M NMA . HA better vs GC or PBO in WOMAC pain, stiffness, function and OARSI criteria. No diff in AE Gallagher HA vs PBO M No MA . No diff in joint space width. High risk of bias. Not reported Samson HA vs Glucosamine; Chondroitin; Lavage M MA . HA better in pain (small effect), unclear clinical benefit MA. More AE with HA. SAE in 3/1002 knees with HA (severe swelling, hypersensitivity reaction) Di PRP vs HA L No MA . PRP better only in WOMAC function. More AE with PRP (p&lt;0.05) SAE in 2 knees with HA (severe swelling) Silvinato* MPA vs TA; TH L MA . MPA better vs TA in pain until w6 No diff. in pain or function at 12w. No diff in AE Trigkilidas HA vs PBO; GC L No MA . HA (small effect) better in mild-moderate OA No diff in AE Lo HA vs PBO L No MA . HA (small effect) better in pain. (publication bias). High heterogeneity No diff in AE De Souza TM OA HA vs GC M HA better in pain at w24 Not reported Figueiredo Hip OA HA vs GC; PBO; PRP; Anaesthetics L MA . No diff in HA vs comparators in pain and OARSI criteria No diff in AE Lee Shoulder capsulitis HA vs SOC M No MA . No diff in HA vs SOC. No diff in AE Heuft RA (knee ) YR vs PBO; GC M No MA. YR better vs PBO, TH better vs YR in ROM and knee circumference. SR inconclusive Not reported Silvinato* MPA vs TA; TH L MA . No diff in pain or function. No diff in AE Saito HA vs PBO L MA . HA better in global effectiveness, pain and inflammation. No diff in AE Conclusion: Most of the SRs assessed had results of low confidence. HA and GC showed a small, short term benefit in knee arthritis in OA and RA compared to PBO. High risk of bias prevents conclusions on the efficacy of PRP and MSC in knee OA. More AE were reported in PRP and HA treated groups. Disclosure of Interests: : Sebastian C Rodriguez-García Speakers bureau: Novartis Farmaceutica, S.A., Merck Sharp &amp; Dohme España, S.A., Sanofi Aventis, UCB Pharma, Raul Castellanos-Moreira Speakers bureau: Lilly, MSD, Sanofi, UCB, Jacqueline Uson Jaeger: None declared, Esperanza Naredo: None declared, Loreto Carmona Grant/research support from: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp &amp; Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution)