ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1441

Marine Oil Supplements for Arthritis Pain: A Systematic Review and Meta-Analysis of Randomized Trials

Ninna Karsbæk Senftleber1,2, Sabrina Mai Nielsen3,4, Jens Rikardt Andersen4, Henning Bliddal5, Simon Tarp3, Lotte Lauritzen4, Daniel E. Furst6, Maria E. Suarez-Almazor7, Anne Lyddiatt8 and Robin Christensen5, 1Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Frederiksberg and Bispebjerg, Denmark, 2Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark, 3Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark, 4Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark, 5The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark, 6Medicine, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, 7General Internal Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, 8Musculoskeletal Group, Cochrane Collaboration, Ottawa, ON, Canada

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: ,

Session Information

Date: Monday, November 9, 2015

Title: Pain: Basic and Clinical Aspects Poster

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

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 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 (I2, 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). https://acrabstracts.org/abstract/marine-oil-supplements-for-arthritis-pain-a-systematic-review-and-meta-analysis-of-randomized-trials/. Accessed .

« Back to 2015 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/marine-oil-supplements-for-arthritis-pain-a-systematic-review-and-meta-analysis-of-randomized-trials/