بررسي اثربخشي باليني داروي گلوكوزآمين در مقايسه با داروهاي كندرويتين سولفات و هيالورونيك اسيد در تسكين درد افراد مبتلا به استئوآرتريت: يك متاآناليز شبكهاي گلوكزآمين، كندرويتين سولفات و هيالورونيك اسيد در تسكين استئوآرتريت ،

Clinical effectiveness of Glucosamine compared to Chondroitin sulfate, hyaluronic acid on relieving pain in people with osteoarthritis: a network meta-analysis

زﻣﯿﻨﻪ و ﻫﺪف ﺗﺎ ﮐﻨﻮن ﭘﮋوﻫﺸــﯽ ﻣﯿﺰان اﺛﺮﺑﺨﺸــﯽ ﻓﺮمﻫﺎي ﺗﺰرﯾﻘﯽ و ﺧﻮراﮐﯽ داروي ﮔﻠﻮﮐﻮزآﻣﯿﻦ را در ﻗﯿﺎس ﺑﺎ داروﻫﺎي ﮐﻨﺪروﯾﺘﯿﻦ ﺳــﻮﻟﻔﺎت و ﻫﯿﺎﻟﻮروﻧﯿﮏ ﺑﺮ ﻋﻤﻠﮑﺮد ﻓﯿﺰﯾﮑﯽ و درد ﺑﯿﻤﺎرن ﻣﺒﺘﻠﺎ ﺑﻪ اﺳــﺘﺌﻮآرﺗﺮﺑﺖ ﺑﺮرﺳــﯽ ﻧﮑﺮده اﺳــﺖ. ﻫﺪف از ﭘﮋوﻫﺶ ﺣﺎﺿــﺮ ﺑﺮرﺳــﯽ اﺛﺮﺑﺨﺸــﯽ ﺑﺎﻟﯿﻨﯽ داروي ﮔﻠﻮﮐﻮزآﻣﯿﻦ در ﻣﻘﺎﯾﺴــﻪ ﺑﺎ داروﻫﺎي ﮐﻨﺪروﯾﺘﯿﻦ ﺳﻮﻟﻔﺎت و ﻫﯿﺎﻟﻮروﻧﯿﮏ در ﺗﺴﮑﯿﻦ درد و ﻋﻤﻠﮑﺮد اﻓﺮاد ﻣﺒﺘﻠﺎ ﺑﻪ اﺳﺘﺌﻮآرﺗﺮﯾﺖ اﺳﺖ. ﻣﻮاد و روشﻫﺎ ﭘﺎﯾﮕﺎهﻫﺎي اﻃﻠﺎﻋﺎﺗﯽ ﭘﺎﺑﻤﺪ، اﺳﮑﻮﭘﻮس، ﮔﻮﮔﻞ اﺳﮑﻮﻟﺎر و ﮐﺎﮐﺮن ﺗﺎ ﺗﺎرﯾﺦ آﺑﺎن 1397 ﺟﺴﺖوﺟﻮ ﺷﺪ. از روش pairwise ﺑﺮاي ﻣﻘﺎﯾﺴﮥ اﺧﺘﻠﺎف ﻣﯿﺎﻧﮕﯿﻦ اﻣﺘﯿﺎز ﻓﺮمﻫﺎي ارزﯾﺎﺑﯽ ﭘﯿﺶ و ﭘﺲ از ﻣﺪاﺧﻠﮥ داروﻫﺎ در دو ﺣﺎﻟﺖ ﻣﺴﺘﻘﯿﻢ)ﻣﻘﺎﯾﺴﮥ داروﻫﺎ ﺑﺎ ﮔﺮوه ﮐﻨﺘﺮل( و ﻏﯿﺮﻣﺴﺘﻘﯿﻢ)ﻣﻘﺎﯾﺴﮥ داروﻫﺎ ﺑﺎ ﯾﮏدﯾﮕﺮ( اﺳﺘﻔﺎده ﺷﺪ. ﯾﺎﻓﺘﻪﻫﺎ ﭘﮋوﻫﺶ ﺣﺎﺿﺮ ﻧﺸﺎن داد ﮐﻪ در ﺑﻬﺒﻮد ﻋﻤﻠﮑﺮد ﺑﯿﻤﺎران ﻣﺒﺘﻠﺎ ﺑﻪ اﺳﺘﺌﻮآرﺗﺮﯾﺖ در اﻣﺘﯿﺎز ﻓﺮم WOMAC اﺑﺘﺪا ﻓﺮم دﻫﺎﻧﯽ ﮐﻨﺪروﯾﺘﯿﻦ ﺳﻮﻟﻔﺎت ﺑﺎ 3/90- اﻣﺘﯿﺎز و ﭘﺲ از آن ﺑﻪﺗﺮﺗﯿﺐ ﻓﺮم ﺗﺰرﯾﻘﯽ ﮐﻨﺪروﯾﺘﯿﻦ ﺳﻮﻟﻔﺎت و ﻓﺮم ﺗﺰرﯾﻘﯽ ﮔﻠﻮﮐﺰآﻣﯿﻦ دارد. درﺑﺎرة ارزﯾﺎﺑﯽ درد ﺑﯿﻤﺎران ﻣﺒﺘﻠﺎ ﺑﻪ اﺳﺘﺌﻮآرﺗﺮﯾﺖ ﺑﯿﺸﺘﺮﯾﻦ ﮐﺎﻫﺶ درد را در اﺑﺘﺪا ﻓﺮم ﺗﺰرﯾﻘﯽ ﻫﯿﺎﻟﻮروﻧﯿﮏ اﺳﯿﺪ و ﺳﭙﺲ ﻓﺮم دﻫﺎﻧﯽ ﮐﻨﺪروﯾﺘﯿﻦ ﺳﻮﻟﻔﺎت ﻧﺸﺎن دادﻧﺪ. ارزﯾﺎﺑﯽ درد ﺑﺎ اﺳﺘﻔﺎده از ﻓﺮم VASﻓﺮم دﻫﺎﻧﯽ ﮔﻠﻮﮐﺰآﻣﯿﻦ داراي ﮐﺎﻫﺶ ﺑﻮد. ﻧﺘﯿﺠﻪﮔﯿﺮي ﭘﮋوﻫﺶ ﺣﺎﺿﺮ ﻧﺸﺎن داد ﮐﻪ در ﻣﻘﺎﯾﺴﻪ ﺑﺎ ﮔﺮو داروﻧﻤﺎ ﺑﻬﺒﻮد در ﻋﻤﻠﮑﺮد ﻓﯿﺰﯾﮑﯽ ﺑﺎ ﻣﺼﺮف ﻓﺮم دﻫﺎﻧﯽ ﮐﻨﺪروﯾﺘﯿﻦ ﺳﻮﻟﻔﺎت ﺑﯿﺸﺘﺮﯾﻦ ﺗﺄﺛﯿﺮ را داﺷﺖ. در ارزﯾﺎﺑﯽ درد ﺗﻮﺳﻂ ﻓﺮم WOMAC و VAS ﺑﻪﺗﺮﺗﯿﺐ ﻓﺮم ﺗﺰرﯾﻘﯽ ﻫﯿﺎﻟﻮروﻧﯿﮏ اﺳﯿﺪ و ﻓﺮم دﻫﺎﻧﯽ ﮔﻠﻮﮐﺰآﻣﯿﻦ ﺑﯿﺸﺘﺮﯾﻦ ﺑﻬﺒﻮد را ﻧﺴﺒﺖ ﺑﻪ داروﻫﺎي دﯾﮕﺮ ﻧﺸﺎن دادﻧﺪ.

Introduction: So far, no study has ever surveyed the effectiveness of injectable and oral forms of the Glucosamine compared with chondroitin sulfate and hyaluronic acid on physical function and pain in osteoarthritic patients. The aim of this study is to evaluate the clinical efficacy of glucosamine compared with chondroitin sulfate and hyaluronic acid in relieving pain and function of people with osteoarthritis. Materials and Methods: The databases of PubMed, Scopus, Google Scholar and Cochran were searched up to November 2018. The pairwise method was used to compare the difference between the mean score of the evaluation forms before and after the intervention in two methods including direct (comparison of drugs with the control group) and non-direct (comparison of drugs with each other). Results: The present study showed that improvement in the performance of patients with osteoarthritis according to the WOMAC score, was the highest with oral form of chondroitin sulfate and then the injectable form of chondroitin sulfate and injectable form of glucosamine. Pain evaluation of patients showed the most pain reduction in the injectable form of hyaluronic acid and then the oral form of chondroitin sulfate. Pain assessment via the VAS form, showed that oral form of glucosamine alleviated the pain. Conclusion: This study demonstrated that, intake of oral form of chondroitin sulfate had the most effect on improving the physical function. Also, in the assessment of pain using WOMAC and VAS forms, the injectable form of hyaluronic acid and oral form glucosamine showed the highest improvement compared to other drugs.