Duloxetine in OsteoArthritis (DOA) study: effects of duloxetine on pain and function in end-stage hip and knee OA – a pragmatic enriched randomized controlled trial

BMC Musculoskeletal Disorders

A. J. ten Hagen¹  T. M. van Raaij²  B. Dijkstra³  W. P. Zijlstra³  M. Stevens⁴  S. K. Bulstra⁴  I. van den Akker-Scheek⁴  W. Rienstra⁵  T. Blikman⁵ 

[1] Department of Anaesthesiology, Martini Hospital Groningen, Groningen, The Netherlands;Department of Orthopedics, Martini Hospital Groningen, Groningen, The Netherlands;Department of Orthopedics, Medical Center Leeuwarden, Leeuwarden, The Netherlands;Department of Orthopedics, University of Groningen, University Medical Center Groningen, P.O. Box 30001, 9700, Groningen, RB, The Netherlands;Department of Orthopedics, University of Groningen, University Medical Center Groningen, P.O. Box 30001, 9700, Groningen, RB, The Netherlands;Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, P.O. Box 30001, 9700, Groningen, RB, The Netherlands;

关键词: Duloxetine;    Osteoarthritis;    Hip;    Knee;    Pain;   

DOI  :  10.1186/s12891-022-05034-0

来源: Springer

【 摘 要 】

BackgroundSome osteoarthritis (OA) patients experience inadequate pain relief from analgesics like acetaminophen and nonsteroidal anti-inflammatory drugs. This could be the result of experienced non-nociceptive centralized pain. Placebo-controlled randomized trials (RCT) have proven the effectiveness of duloxetine for OA and several chronic pain conditions where central sensitization (CS) is one of the key underlying pain mechanisms.ObjectivesAssess the efficacy of an 8-week duloxetine treatment compared to usual care in end-stage knee and hip OA patients with a level of centralized pain.DesignPragmatic, enriched, open-label RCT.MethodsPatients were randomized to duloxetine or to care-as-usual. Primary outcome was pain in the index joint, measured with the pain domain of the Knee injury and Osteoarthritis Outcome Score (KOOS) or the Hip disability and Osteoarthritis Outcome Score (HOOS). The intention-to-treat principle was used, with mixed-model repeated measures to analyze the effect.ResultsOne hundred eleven patients were randomized. Nearly 44% felt much to very much better after duloxetine usage compared to 0% in the care-as-usual group (p < 0.001). The duloxetine group scored 11.3 points (95%CI: 5.8, 16.8) better on the pain domain of the KOOS/HOOS (p < 0.001). Knee patients improved significantly more than hip patients (18.7 [95%CI: 11.3, 26.1] versus 6.0 [95%CI: − 2.6, 14.5] points better).ConclusionsAdding duloxetine treatment seems to be beneficial for end-stage knee OA patients with neuropathic-like symptoms (at risk of CS). End stage Hip OA patients seem to be nonresponsive to duloxetine.Trial registrationDutch Trial Registry with number NTR 4744 (15/08/2014) and in the EudraCT database with number 2013–004313-41.

【 授权许可】

CC BY