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6 January 2015

Comparative Effectiveness of Pharmacologic Interventions for Knee Osteoarthritis: A Systematic Review and Network Meta-analysis

Authors: Raveendhara R. Bannuru, MD, Christopher H. Schmid, PhD, David M. Kent, MD, Elizaveta E. Vaysbrot, MD, John B. Wong, MD, and Timothy E. McAlindon, MDAuthor, Article, & Disclosure Information
Publication: Annals of Internal Medicine
Volume 162, Number 1
https://doi.org/10.7326/M14-1231
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Abstract

Background:

The relative efficacy of available treatments of knee osteoarthritis (OA) must be determined for rational treatment algorithms to be formulated.

Purpose:

To examine the efficacy of treatments of primary knee OA using a network meta-analysis design, which estimates relative effects of all treatments against each other.

Data Sources:

MEDLINE, EMBASE, Web of Science, Google Scholar, Cochrane Central Register of Controlled Trials from inception through 15 August 2014, and unpublished data.

Study Selection:

Randomized trials of adults with knee OA comparing 2 or more of the following: acetaminophen, diclofenac, ibuprofen, naproxen, celecoxib, intra-articular (IA) corticosteroids, IA hyaluronic acid, oral placebo, and IA placebo.

Data Extraction:

Two reviewers independently abstracted study data and assessed study quality. Standardized mean differences were calculated for pain, function, and stiffness at 3-month follow-up.

Data Synthesis:

Network meta-analysis was performed using a Bayesian random-effects model; 137 studies comprising 33 243 participants were identified. For pain, all interventions significantly outperformed oral placebo, with effect sizes from 0.63 (95% credible interval [CrI], 0.39 to 0.88) for the most efficacious treatment (hyaluronic acid) to 0.18 (CrI, 0.04 to 0.33) for the least efficacious treatment (acetaminophen). For function, all interventions except IA corticosteroids were significantly superior to oral placebo. For stiffness, most of the treatments did not significantly differ from one another.

Limitation:

Lack of long-term data, inadequate reporting of safety data, possible publication bias, and few head-to-head comparisons.

Conclusion:

This method allowed comparison of common treatments of knee OA according to their relative efficacy. Intra-articular treatments were superior to nonsteroidal anti-inflammatory drugs, possibly because of the integrated IA placebo effect. Small but robust differences were observed between active treatments. All treatments except acetaminophen showed clinically significant improvement from baseline pain. This information, along with the safety profiles and relative costs of included treatments, will be helpful for individualized patient care decisions.

Primary Funding Source:

Agency for Healthcare Research and Quality.

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Supplement. Data Supplement

References

1.
Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2163-96. [PMID: 23245607]  doi: 10.1016/S0140-6736(12)61729-2
Crossref
PubMed
Google Scholar
2.
Guccione AA, Felson DT, Anderson JJ, Anthony JM, Zhang Y, Wilson PW, et al. The effects of specific medical conditions on the functional limitations of elders in the Framingham Study. Am J Public Health. 1994;84:351-8. [PMID: 8129049]
Crossref
PubMed
Google Scholar
3.
Kosorok MR, Omenn GS, Diehr P, Koepsell TD, Patrick DL. Restricted activity days among older adults. Am J Public Health. 1992;82:1263-7. [PMID: 1503169]
Crossref
PubMed
Google Scholar
4.
The incidence and prevalence database for procedures. Sunnyvale,CA: Timely Data Resources; 1995:592-6.
Google Scholar
5.
White AG, Birnbaum HG, Janagap C, Buteau S, Schein J. Direct and indirect costs of pain therapy for osteoarthritis in an insured population in the United States. J Occup Environ Med. 2008;50:998-1005. [PMID: 18784547]  doi: 10.1097/JOM.0b013e3181715111
Crossref
PubMed
Google Scholar
6.
McGettigan P, Henry D. Use of non-steroidal anti-inflammatory drugs that elevate cardiovascular risk: an examination of sales and essential medicines lists in low-, middle-, and high-income countries. PLoS Med. 2013;10:e1001388. [PMID: 23424288]  doi: 10.1371/journal.pmed.1001388
Crossref
PubMed
Google Scholar
7.
Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J, et al; American College of Rheumatology. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 2012;64:465-74. [PMID: 22563589]
Crossref
PubMed
Google Scholar
8.
McAlindon TE, Bannuru RR, Sullivan MC, Arden NK, Berenbaum F, Bierma-Zeinstra SM, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage. 2014;22:363-88. [PMID: 24462672]  doi: 10.1016/j.joca.2014.01.003
Crossref
PubMed
Google Scholar
9.
Juhl C, Lund H, Roos EM, Zhang W, Christensen R. A hierarchy of patient-reported outcomes for meta-analysis of knee osteoarthritis trials: empirical evidence from a survey of high impact journals. Arthritis. 2012;2012:136245. [PMID: 22792458]  doi: 10.1155/2012/136245
Crossref
PubMed
Google Scholar
10.
Higgins JPT, Green S, eds. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.10. The Cochrane Collaboration; 2011. Accessed at http://handbook.cochrane.org on 13 November 2014.
Google Scholar
11.
Cooper H, Hedges LV. The Handbook of Research Synthesis. New York: Russell Sage Foundation; 1994.
Google Scholar
12.
Dias S, Welton NJ, Sutton AJ, Ades AE. Evidence synthesis for decision making 1: introduction. Med Decis Making. 2013;33:597-606. [PMID: 23804506]  doi: 10.1177/0272989X13487604
Crossref
PubMed
Google Scholar
13.
Salanti G. Indirect and mixed-treatment comparison, network, or multiple-treatments meta-analysis: many names, many benefits, many concerns for the next generation evidence synthesis tool. Research Synthesis Methods. 2012;3:80-97.  doi: 10.1002/jrsm.1037
Crossref
PubMed
Google Scholar
14.
Dias S, Sutton AJ, Ades AE, Welton NJ. Evidence synthesis for decision making 2: a generalized linear modeling framework for pairwise and network meta-analysis of randomized controlled trials. Med Decis Making. 2013;33:607-17. [PMID: 23104435]  doi: 10.1177/0272989X12458724
Crossref
PubMed
Google Scholar
15.
Franchini A, Dias S, Ades A, Jansen J, Welton N. Accounting for correlation in network meta-analysis with multi-arm trials. Research Synthesis Methods. 2012;3:142-60.  doi: 10.1002/sim.6321
Crossref
PubMed
Google Scholar
16.
Higgins JP, Whitehead A. Borrowing strength from external trials in a meta-analysis. Stat Med. 1996;15:2733-49. [PMID: 8981683]
Crossref
PubMed
Google Scholar
17.
Smith TC, Spiegelhalter DJ, Thomas A. Bayesian approaches to random-effects meta-analysis: a comparative study. Stat Med. 1995;14:2685-99. [PMID: 8619108]
Crossref
PubMed
Google Scholar
18.
Lu G, Ades AE. Combination of direct and indirect evidence in mixed treatment comparisons. Stat Med. 2004;23:3105-24. [PMID: 15449338]
Crossref
PubMed
Google Scholar
19.
Baker SG, Kramer BS. The transitive fallacy for randomized trials: if A bests B and B bests C in separate trials, is A better than C? BMC Med Res Methodol. 2002;2:13. [PMID: 12429069]
Crossref
PubMed
Google Scholar
20.
Cipriani A, Higgins JP, Geddes JR, Salanti G. Conceptual and technical challenges in network meta-analysis. Ann Intern Med. 2013;159:130-7. [PMID: 23856683]  doi: 10.7326/0003-4819-159-2-201307160-00008
Link
Google Scholar
21.
Dias S, Welton NJ, Caldwell DM, Ades AE. Checking consistency in mixed treatment comparison meta-analysis. Stat Med. 2010;29:932-44. [PMID: 20213715]  doi: 10.1002/sim.3767
Crossref
PubMed
Google Scholar
22.
Thorlund K, Walter SD, Johnston BC, Furukawa TA, Guyatt GH. Pooling health-related quality of life outcomes in meta-analysis—a tutorial and review of methods for enhancing interpretability. Research Synthesis Methods. 2011;2:188-203.  doi: 10.1002/jrsm.46
Crossref
PubMed
Google Scholar
23.
Pham T, van der Heijde D, Altman RD, Anderson JJ, Bellamy N, Hochberg M, et al. OMERACT-OARSI initiative: Osteoarthritis Research Society International set of responder criteria for osteoarthritis clinical trials revisited. Osteoarthritis Cartilage. 2004;12:389-99. [PMID: 15094138]
Crossref
PubMed
Google Scholar
24.
Dias S, Sutton AJ, Welton NJ, Ades AE. Evidence synthesis for decision making 3: heterogeneity—subgroups, meta-regression, bias, and bias-adjustment. Med Decis Making. 2013;33:618-40. [PMID: 23804507]  doi: 10.1177/0272989X13485157
Crossref
PubMed
Google Scholar
25.
Rutjes AW, Jüni P, da Costa BR, Trelle S, Nüesch E, Reichenbach S. Viscosupplementation for osteoarthritis of the knee: a systematic review and meta-analysis. Ann Intern Med. 2012;157:180-91. [PMID: 22868835]  doi: 10.7326/0003-4819-157-3-201208070-00473
Link
Google Scholar
26.
American Academy of Orthopaedic Surgeons. Treatment of osteoarthritis of the knee: evidence-based guideline. 2nd edition. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2013. Accessed at www.aaos.org/research/guidelines/treatmentofOsteoarthritisoftheKneeGuideline.pdf on 13 November 2014.
Google Scholar
27.
Bannuru RR, Natov NS, Dasi UR, Schmid CH, McAlindon TE. Therapeutic trajectory following intra-articular hyaluronic acid injection in knee osteoarthritis—meta-analysis. Osteoarthritis Cartilage. 2011;19:611-9. [PMID: 21443958]  doi: 10.1016/j.joca.2010.09.014
Crossref
PubMed
Google Scholar
28.
Zhang RX, Ren K, Dubner R. Osteoarthritis pain mechanisms: basic studies in animal models. Osteoarthritis Cartilage. 2013;21:1308-15. [PMID: 23973145]  doi: 10.1016/j.joca.2013.06.013
Crossref
PubMed
Google Scholar
29.
Gulen H, Ataoglu H, Haliloglu S, Isik K. Proinflammatory cytokines in temporomandibular joint synovial fluid before and after arthrocentesis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107:e1-4. [PMID: 19426899]  doi: 10.1016/j.tripleo.2009.02.006
Crossref
PubMed
Google Scholar
30.
Kirwan JR, Rankin E. Intra-articular therapy in osteoarthritis. Baillieres Clin Rheumatol. 1997;11:769-94. [PMID: 9429736]
Crossref
PubMed
Google Scholar
31.
Zhang W, Jones A, Doherty M. Does paracetamol (acetaminophen) reduce the pain of osteoarthritis? A meta-analysis of randomised controlled trials. Ann Rheum Dis. 2004;63:901-7. [PMID: 15020311]
Crossref
PubMed
Google Scholar
32.
Lee C, Hunsche E, Balshaw R, Kong SX, Schnitzer TJ. Need for common internal controls when assessing the relative efficacy of pharmacologic agents using a meta-analytic approach: case study of cyclooxygenase 2-selective inhibitors for the treatment of osteoarthritis. Arthritis Rheum. 2005;53:510-8. [PMID: 16082648]
Crossref
PubMed
Google Scholar
33.
Stam W, Jansen J, Taylor S. Efficacy of etoricoxib, celecoxib, lumiracoxib, non-selective NSAIDs, and acetaminophen in osteoarthritis: a mixed treatment comparison. Open Rheumatol J. 2012;6:6-20. [PMID: 22582102]  doi: 10.2174/1874312901206010006
Crossref
PubMed
Google Scholar
34.
Bannuru RR, Vaysbrot EE, Sullivan MC, McAlindon TE. Relative efficacy of hyaluronic acid in comparison with NSAIDs for knee osteoarthritis: a systematic review and meta-analysis. Semin Arthritis Rheum. 2014;43:593-9. [PMID: 24216297]  doi: 10.1016/j.semarthrit.2013.10.002
Crossref
PubMed
Google Scholar
35.
Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G. Intraarticular corticosteroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2006:CD005328. [PMID: 16625636]
PubMed
Google Scholar
36.
Arroll B, Goodyear-Smith F. Corticosteroid injections for osteoarthritis of the knee: meta-analysis. BMJ. 2004;328:869. [PMID: 15039276]
Crossref
PubMed
Google Scholar
37.
Bannuru RR, Natov NS, Obadan IE, Price LL, Schmid CH, McAlindon TE. Therapeutic trajectory of hyaluronic acid versus corticosteroids in the treatment of knee osteoarthritis: a systematic review and meta-analysis. Arthritis Rheum. 2009;61:1704-11. [PMID: 19950318]  doi: 10.1002/art.24925
Crossref
PubMed
Google Scholar
38.
Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G. Viscosupplementation for the treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2006:CD005321. [PMID: 16625635]
PubMed
Google Scholar
39.
Cooper NJ, Sutton AJ, Morris D, Ades AE, Welton NJ. Addressing between-study heterogeneity and inconsistency in mixed treatment comparisons: Application to stroke prevention treatments in individuals with non-rheumatic atrial fibrillation. Stat Med. 2009;28:1861-81. [PMID: 19399825]  doi: 10.1002/sim.3594
Crossref
PubMed
Google Scholar

Comments

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Raveendhara R. Bannuru, MD; David M. Kent, MD; and Timothy E. McAlindon, MD26 February 2015
Author's Response
We thank Dr. Marcus for his insightful comments and wholeheartedly agree that all articles should be faithfully reported and not spun to meet marketing agendas. We agree that comparison of intra-articular hyaluronic acid to intra-articular placebos is scientifically valuable, but we also maintain that comparison to oral placebo is valuable as well. Both comparisons give valid estimates of treatment effect—but with different meanings. The former measures an explanatory treatment effect that might be a better measure of the incremental effect due to the biological activity of hyaluronic acid over and above a (potentially) pharmacodynamically inactive saline injection. The latter, however, gives a more pragmatic measure, which is likely to be a better indicator of the degree of relief a patient will feel—since it incorporates all modes of intra-articular hyaluronic acid activity. For the purposes of comparative effectiveness research, we feel the comparison to oral placebo provides a better evidentiary basis for clinical decision making.

Our network meta-analysis enabled us to estimate the comparative effectiveness of intra-articulars relative to oral agents, and rank these effects in a way that has clinical utility.1 The fact that the derived comparative effect may incorporate a component of a placebo response should prompt thought and discussion as to how to reformulate how we think about its role in therapy and practice of medicine. Therefore, we should think carefully before making strong negative recommendations for therapeutic products that have good comparative effectiveness, especially for conditions for which use of the limited number of alternatives is often precluded by comorbid contra-indications. These complex considerations may explain why there are differences between consensus recommendations from different groups in regard to products such as HA.2-4


1. Bannuru RR, Schmid CH, Kent DM, Vaysbrot EE, Wong JB, McAlindon TE. Comparative Effectiveness of Pharmacologic Interventions for Knee Osteoarthritis: A Systematic Review and Network Meta-analysis. Annals of internal medicine. Jan 6 2015;162(1):46-54.
2. Brown GA. AAOS clinical practice guideline: treatment of osteoarthritis of the knee: evidence-based guideline, 2nd edition. The Journal of the American Academy of Orthopaedic Surgeons. Sep 2013;21(9):577-579.
3. Hochberg MC, Altman RD, April KT, et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis care & research. Apr 2012;64(4):465-474.
4. McAlindon TE, Bannuru RR, Sullivan MC, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society. Mar 2014;22(3):363-388.


Donald M. Marcus, MD29 January 2015
Pharmacologic Interventions for Knee Osteoarthritis
In their complex review of pharmacologic interventions for treatment of knee osteoarthritis (1), Bannuru et al. reported that intraarticular hyaluronic acid had the highest effect size for relief of pain compared to an oral placebo. That comparison is misleading because the appropriate control for intraarticular hyaluronic is an intraarticular placebo injection. Although the authors and the accompanying editorial (2) note that the apparent efficacy of hyaluronic acid may result from the stronger placebo effect of an injection, the comparison with an oral placebo gives unwarranted credibility to the efficacy of hyaluronic acid, and it is subject to misinterpretation. For example, a commentary by a physician in an online medical newsletter (3) ignored the issue of placebo effects, and called into question recommendations against the use of hyaluronic acid. Another online newsletter (4) cited the biggest benefit from hyaluronic acid and failed to consier data from other reviews and guidelines.
The best evidence is that intraarticular hyaluronic acid has no clinically meaningful benefit for knee osteoarthritis compared to an intraarticular placebo injection (5). The guidelines of the American Academy of Orthopedic Physicians contains a strong recommendation against the use of hyaluronic acid for treatment of knee osteoarthritis (6). The review by Bannuru et al. provides no basis for reconsidering current guidelines.
Despite the lack of evidence supporting its use, injections of hyaluronic acid for knee osteoarthritis are used widely. It is unfortunate that this paper may well be misquoted in other popular health media and in advertisements as providing evidence for the benefits of hyaluronic acid.
References
1. Bannuru RR, Schmid CH, Kent DM, Vaysbrot EE, Wong JB, McAlindon TE. Comparative effectivenesss of pharmacologic interventions for knee osteoarthritis. Ann Int Med 2015; 162: 46-54.
2. Mandl LA, Losina E. Relative efficacy of knee osteoarthritis treatments: Are all placebos created equal? Ann Int med 2015; 162:71-2.
3. Altman R. Next round on hyaluronic acid: Better even than acetaminophen? New data call AAOS recommendations into question? http://www.medpagetoday.com/Rheumatology/Arthritis /49 1/23/2015.
4. Norton A. Knee arthritis drugs beat placebos, but study finds no clear winner. Health Day http://consumerhealthday.com January 6, 2015, accesed January 26, 2015.
5. Rutjes AWS, Juni P, da Costa BR, Trelle S, Nuesch E, Reichenbach S. Viscosupplementation for osteoarhritis of the knee. Ann Intern Med 2012; 157:180-91.
6. American Academy of Orthopedic Surgeons. Treament of osteoarthritis of the knee:evidence-based guidelines. 2nd edition. Rosement, IL: American Academy of Orthopedic Surgeons; 2013. Accessed at www.aaos.org January 29, 2015

Information & Authors

Information

Published In

cover image Annals of Internal Medicine
Annals of Internal Medicine
Volume 162 • Number 1 • 6 January 2015
Pages: 46 - 54

History

Published online: 6 January 2015
Published in issue: 6 January 2015

Keywords

  1. Adverse events
  2. Drugs
  3. Ibuprofen
  4. Knees
  5. Network analysis
  6. NSAIDs
  7. Osteoarthritis
  8. Research design
  9. Rheumatology
  10. Stiffness

Copyright

© 2015 American College of Physicians.

Authors

Affiliations

Raveendhara R. Bannuru, MD
From Center for Treatment Comparison and Integrative Analysis, Predictive Analytics and Comparative Effectiveness Center, and Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, and Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, Massachusetts, and Center for Evidence Based Medicine and Brown University School of Public Health, Providence, Rhode Island.
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Christopher H. Schmid, PhD
From Center for Treatment Comparison and Integrative Analysis, Predictive Analytics and Comparative Effectiveness Center, and Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, and Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, Massachusetts, and Center for Evidence Based Medicine and Brown University School of Public Health, Providence, Rhode Island.
View all articles by this author
David M. Kent, MD
From Center for Treatment Comparison and Integrative Analysis, Predictive Analytics and Comparative Effectiveness Center, and Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, and Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, Massachusetts, and Center for Evidence Based Medicine and Brown University School of Public Health, Providence, Rhode Island.
View all articles by this author
Elizaveta E. Vaysbrot, MD
From Center for Treatment Comparison and Integrative Analysis, Predictive Analytics and Comparative Effectiveness Center, and Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, and Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, Massachusetts, and Center for Evidence Based Medicine and Brown University School of Public Health, Providence, Rhode Island.
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John B. Wong, MD
From Center for Treatment Comparison and Integrative Analysis, Predictive Analytics and Comparative Effectiveness Center, and Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, and Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, Massachusetts, and Center for Evidence Based Medicine and Brown University School of Public Health, Providence, Rhode Island.
View all articles by this author
Timothy E. McAlindon, MD
From Center for Treatment Comparison and Integrative Analysis, Predictive Analytics and Comparative Effectiveness Center, and Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, and Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, Massachusetts, and Center for Evidence Based Medicine and Brown University School of Public Health, Providence, Rhode Island.
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Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality (AHRQ).
Acknowledgment: The authors thank Matthew Sullivan for his contributions to this work.
Grant Support: By the AHRQ (grants F32HS021396 and R01-HS018574; Drs. Bannuru and Schmid, respectively).
Disclosures: Dr. Bannuru reports grants from AHRQ during the conduct of the study. Dr. Wong reports grants from Patient-Centered Outcomes Research Institute and National Institutes of Health National Center for Complementary and Alternative Medicine and nonfinancial support from European League Against Rheumatism outside the submitted work. Dr. McAlindon reports grants from Croma, Flexion Therapeutics, National Institutes of Health, and AHRQ; and personal fees from Bioventus outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-1231.
Corresponding Author: Raveendhara R. Bannuru, MD, Center for Treatment Comparison and Integrative Analysis, Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Box 406, Boston, MA 02111; e-mail, [email protected].
Current Author Addresses: Drs. Bannuru, Vaysbrot, and McAlindon: Center for Treatment Comparison and Integrative Analysis, Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Boston, MA 02111.
Drs. Kent and Wong: Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington Street, Boston, MA 02111.
Dr. Schmid: Brown University School of Public Health, 121 South Main Street, Providence, RI 02912.
Author Contributions: Conception and design: R.R. Bannuru, C.H. Schmid, T.E. McAlindon.
Analysis and interpretation of the data: R.R. Bannuru, C.H. Schmid, D.M. Kent, J.B. Wong, T.E. McAlindon.
Drafting of the article: R.R. Bannuru, C.H. Schmid, J.B. Wong.
Critical revision of the article for important intellectual content: R.R. Bannuru, C.H. Schmid, D.M. Kent, E.E. Vaysbrot, J.B. Wong, T.E. McAlindon.
Final approval of the article: R.R. Bannuru, C.H. Schmid, D.M. Kent, E.E. Vaysbrot, J.B. Wong, T.E. McAlindon.
Provision of study materials or patients: R.R. Bannuru.
Statistical expertise: R.R. Bannuru, C.H. Schmid.
Obtaining of funding: R.R. Bannuru.
Administrative, technical, or logistic support: R.R. Bannuru, E.E. Vaysbrot.
Collection and assembly of data: R.R. Bannuru, E.E. Vaysbrot.

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Raveendhara R. Bannuru, Christopher H. Schmid, David M. Kent, et al. Comparative Effectiveness of Pharmacologic Interventions for Knee Osteoarthritis: A Systematic Review and Network Meta-analysis. Ann Intern Med.2015;162:46-54. [Epub 6 January 2015]. doi:10.7326/M14-1231

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