Article type
Abstract
Background:
Stem cell therapy is often promoted as a treatment for knee osteoarthritis, despite uncertainty about efficacy and safety. The number of RCTs of stem cell therapies has rapidly increased in recent years. High quality synthesis of data from randomised controlled trials (RCTs) is important to aid consumers, clinicians and policymakers to make informed decisions about new interventions.
Objective:
We sought to compare published systematic reviews of stem cell injections for knee osteoarthritis with a recent Cochrane systematic review performed using living methodology.
Methods:
We searched PubMed to 30 June 2023 for systematic reviews of trials of stem cell therapies in people with osteoarthritis of the knee. One author extracted data including the search date, included trials, inclusion of harm outcomes, and overall assessment of efficacy.
Results:
The Cochrane review (search date September 2023) included 25 RCTs. We identified 42 systematic reviews of stem cell injections for knee osteoarthritis. There was considerable diversity in the stem cell interventions that were included. None of the reviews included more than 13 of the 25 trials included in the Cochrane review. Older reviews rapidly lost currency as new trials emerged but many reviews did not include trials that would have met their inclusion criteria at the time of their literature search. Twenty-four (57%) reviews included non-randomised or observational studies. Six (14%) reviews incorporated a network meta-analysis. Only five (12%) reviews concluded that the efficacy of stem cell injections for knee osteoarthritis had not been demonstrated. Potential harms, particularly serious adverse events, were variably reported in the reviews, and 12 (29%) reviews did not include adverse events as an outcome.
Conclusions:
Systematic reviews on stem cell treatments for knee osteoarthritis exhibit substantial overlap and variability. A high-quality living systematic review is likely to reduce redundant research effort and provide a trustworthy, up-to-date synthesis of efficacy and safety for decision-makers.
Stem cell therapy is often promoted as a treatment for knee osteoarthritis, despite uncertainty about efficacy and safety. The number of RCTs of stem cell therapies has rapidly increased in recent years. High quality synthesis of data from randomised controlled trials (RCTs) is important to aid consumers, clinicians and policymakers to make informed decisions about new interventions.
Objective:
We sought to compare published systematic reviews of stem cell injections for knee osteoarthritis with a recent Cochrane systematic review performed using living methodology.
Methods:
We searched PubMed to 30 June 2023 for systematic reviews of trials of stem cell therapies in people with osteoarthritis of the knee. One author extracted data including the search date, included trials, inclusion of harm outcomes, and overall assessment of efficacy.
Results:
The Cochrane review (search date September 2023) included 25 RCTs. We identified 42 systematic reviews of stem cell injections for knee osteoarthritis. There was considerable diversity in the stem cell interventions that were included. None of the reviews included more than 13 of the 25 trials included in the Cochrane review. Older reviews rapidly lost currency as new trials emerged but many reviews did not include trials that would have met their inclusion criteria at the time of their literature search. Twenty-four (57%) reviews included non-randomised or observational studies. Six (14%) reviews incorporated a network meta-analysis. Only five (12%) reviews concluded that the efficacy of stem cell injections for knee osteoarthritis had not been demonstrated. Potential harms, particularly serious adverse events, were variably reported in the reviews, and 12 (29%) reviews did not include adverse events as an outcome.
Conclusions:
Systematic reviews on stem cell treatments for knee osteoarthritis exhibit substantial overlap and variability. A high-quality living systematic review is likely to reduce redundant research effort and provide a trustworthy, up-to-date synthesis of efficacy and safety for decision-makers.