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11/4/2015 MarineOilSupplementsforArthritisPain:ASystematicReviewandMetaAnalysisofRandomizedTrialsACRMeetingAbstracts
http://acrabstracts.org/abstract/marineoilsupplementsforarthritis painasystematicreviewandmetaanalysisofrandomizedtrials/ 1/2
Date: Monday, November 9, 2015
Session Title: Pain: Basic and Clinical
Aspects Poster
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
ABSTRACT NUMBER: 1441
Marine Oil Supplements for Arthritis Pain: A Systematic
Review and Meta-Analysis of Randomized Trials
Ninna Karsbæk Senftleber , Sabrina Mai Nielsen , Jens Rikardt Andersen , Henning Bliddal ,
Simon Tarp , Lotte Lauritzen , Daniel E. Furst , Maria E. Suarez-Almazor , Anne Lyddiatt and Robin
Christensen , Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology,
Copenhagen University Hospital, Bispebjerg and Frederiksberg, Frederiksberg and Bispebjerg,
Denmark, Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg,
Denmark, Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology,
Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark, Department
of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark, The Parker
Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and
Frederiksberg, Copenhagen, Denmark, Medicine, University of California, Los Angeles, David Geffen
School of Medicine, Los Angeles, CA, General Internal Medicine, The University of Texas, MD
Anderson Cancer Center, Houston, TX, Musculoskeletal Group, Cochrane Collaboration, Ottawa, ON,
Canada
Meeting: 2015 ACR/ARHP Annual Meeting
Date of first publication: September 29, 2015
Keywords: Arthritis, meta-analysis and pain management
SESSION INFORMATION
Background/Purpose: Marine oil supplements (MOS) are suggested to have anti-inflammatory
properties, but there is no consensus regarding the efficacy of MOS in the management of arthritis.
The objective was to evaluate whether oral MOS improve pain and other clinical features in patients
with any type of arthritis.
Methods: Included in the systematic review were randomized trials comparing an MOS, with no
marine oil supplementation (i.e., add-on designs) with trial duration of at least 2 weeks in patients
with any type of arthritis, at any age and gender. Trials that collected some patient-reported pain
outcome were considered eligible for meta-analysis. A systematic search was applied (02.24.15) to
Medline, Web of Science, The Cochrane Central Register of Controlled Trials, EMBASE,
ClinicalTrials.gov, and the World Health Organization International Clinical Trial Registry Platform
portal. Assessment for inclusion, data extraction and bias assessment were done independently by 2
reviewers. Data were extracted using a standardized form. Risk of bias was assessed using the
Cochrane Risk of Bias tool. Standardized mean differences (SMD) were calculated, using Hedges’s
adjustment. Random-effects meta-analysis was used to pool the trial data and heterogeneity was
explored using REML-based meta-regression analysis (R software).
Results: From 65 potentially eligible trials included in the systematic review, 42 trials met inclusion
1,2 3,4 4 5
3 4 6 7 8
5 1
2
3
4
5
6
7
8
11/4/2015 MarineOilSupplementsforArthritisPain:ASystematicReviewandMetaAnalysisofRandomizedTrialsACRMeetingAbstracts
http://acrabstracts.org/abstract/marineoilsupplementsforarthritis painasystematicreviewandmetaanalysisofrandomizedtrials/ 2/2
criteria for the meta-analysis. Of these, 30 trials had complete data for inclusion, where data on 1509
patients, of whom 781 received an oral MOS, were used. Although substantial heterogeneity was
present (I , 63%), the pooled SMD suggested a favorable association with MOS compared with
control (SMD, -0.24; 95%CI: -0.42 to -0.07); corresponding to an improvement of 8 % on a VAS pain
scale. Inclusion of the trials with non-complete data on pain outcome, and high risk of outcome
reporting bias, using a null imputation, resulted in a lower effect size (42 trials; SMD, -0.16; -0.28 to
-0.03). Meta-regression analysis on the trials with complete data showed a statistically significant
effect in rheumatoid arthritis (RA) patients (22 trials; SMD, -0.21; -0.42 to -0.0043) but not in patients
with osteoarthritis (OA) (5 trials; SMD, -0.17; -0.57 to 0.24); other/unclear/mixed diagnoses were
described in three trials (-0.63; -1.2 to -0.06). Inadequate blinding of participants and high risk of
attrition bias were associated with higher effect sizes, compared to those with an adequately
reported procedure.
Conclusion: Meta-analytic pooling of all studies across arthritis conditions showed a statistically
significant association between oral MOS and pain (SMD>0.20 indicating clinical significance). A
statistically significant effect was seen in RA patients but not in OA patients. However, our confidence
in the estimate(s) is rated to low-quality evidence due to heterogeneity, and the empirical evidence
suggesting a high risk of bias.
Disclosure: N. K. Senftleber, None; S. M. Nielsen, None; J. R. Andersen, None; H. Bliddal, None; S.
Tarp, None; L. Lauritzen, None; D. E. Furst, Gilead, 2,GlaxoSmithKline, 2,NIH, 2,Novartis
Pharmaceutical Corporation, 2,Pfizer Inc, 2,Roche Pharmaceuticals, 2,Genentech and Biogen IDEC
Inc., 2,UCB, 2,Abbvie, 5,Actelion Pharmaceuticals US, 5,Amgen, 5,Bristol-Myers Squibb, 5,Cytori,
5,Janssen Pharmaceutica Product, L.P., 5,Gilead, 5,GlaxoSmithKline, 5,NIH, 5,Novartis Pharmaceutical
Corporation, 5,Pfizer Inc, 5,Roche Pharmaceuticals, 5,Genentech and Biogen IDEC Inc., 5,UCB,
5,Abbvie, 8,Actelion Pharmaceuticals US, 8,Bristol-Myers Squibb, 2,Amgen, 2,Actelion
Pharmaceuticals US, 2,Abbvie, 2,UCB, 8; M. E. Suarez-Almazor, None; A. Lyddiatt, None; R.
Christensen, None.
To cite this abstract in AMA style:
Senftleber NK, Nielsen SM, Andersen JR, Bliddal H, Tarp S, Lauritzen L, Furst DE, Suarez-Almazor
ME, Lyddiatt A, Christensen R. Marine Oil Supplements for Arthritis Pain: A Systematic Review
and Meta-Analysis of Randomized Trials [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10).
http://acrabstracts.org/abstract/marine-oil-supplements-for-arthritis-pain-a-systematic-review-
and-meta-analysis-of-randomized-trials/. Accessed November 4, 2015.
ACR Meeting Abstracts - http://acrabstracts.org/abstract/marine-oil-supplements-for-arthritis-pain-
a-systematic-review-and-meta-analysis-of-randomized-trials/
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