Is moxibustion effective in symptom management among patients with knee osteoarthritis (KOA) as compared to diclofenac sodium (DS)?
Date of publication of the systematic review: October 2012
Design
Systematic review of 5 randomized clinical trials (RCTs).
Participants
410 patients (mean age range: not reported, male% range: 17.5% to 41%) with 480 knees diagnosed with knee osteoarthritis (KOA) according to the American College of Rheumatology criteria (in one trial), and the Guiding Principles of Clinical Research on New Drugs for TCM criteria (in four trials). No other restrictions were applied on the characteristics of participants by the reviewers.
Intervention
Moxibustion therapy administered with a frequency of once daily in 4 included studies, and once every 2 days in 1 study. The total number of sessions ranged from 10 to 20.
Comparator
Comparison: Moxibustion versus Diclofenac Sodium (DS). DS was administrated orally at a dosage of 75 mg per day for a duration of 20 days in 4 studies, and 15 days in 1 study.
Major Outcomes
Outcome 1: Improvement measured at the end of treatment. However, method for measuring improvement was not clarified in the systematic review.
Outcome 2: Response rate measured after 2 months’ follow-up;
Outcome 3: Level of pain measured by the numeric rating scale (NRS) from baseline to the end of treatment.
Settings
The reviewers did not state whether the included trials were conducted in inpatient or outpatient settings.
Comparison    Moxibustion versus DS
Main Results
Compared to DS, moxibustion showed significant improvement at the end of treatment (pooled relative risk increase (pooled RRI): 11%, 95% CI: 4% to 81%). However, compared to DS, moxibustion did not show favorable improvement measured after two months’ follow-up (pooled RRI: 10%, 95% CI: -3% to 24%), or in reducing the pain level assessed by NRS from baseline to the end of treatment (pooled weighted mean difference (pooled WMD): 0.16, 95% CI: -0.11 to 0.44).
Comparison: Moxibustion versus DS among patients with KOA
Outcomes No. of studies (No. of knees diagnosed as OA) No. of event/ No. of participants Heterogeneity test (I2) Pooled RRI (95% CI) Overall quality of evidence*
Intervention Comparator
1 5 (480) 227/ 242 199/ 238 1% 11% (4% to 81%) Low
2 2 (179) 81/ 91 72/ 89 0% 10% (-3% to 24%) Low
Outcomes No. of studies (No. of knees diagnosed as OA) Mean score / No. of participants Heterogeneity test (I2) Pooled WMD
(95% CI)
Overall quality of evidence*
Intervention Comparator
3 2 (218) 2.17/ 110 2.01/ 108 0% 0.16 (-0.11 to 0.44) Low
Keys: RRI = relative risk increase; WMD = weighted mean difference; CI = confidence interval.
Comparison    Moxibustion versus DS
Main Results
Compared to DS, moxibustion showed significant improvement at the end of treatment (pooled relative risk increase (pooled RRI): 11%, 95% CI: 4% to 81%). However, compared to DS, moxibustion did not show favorable improvement measured after two months’ follow-up (pooled RRI: 10%, 95% CI: -3% to 24%), or in reducing the pain level assessed by NRS from baseline to the end of treatment (pooled weighted mean difference (pooled WMD): 0.16, 95% CI: -0.11 to 0.44).
Comparison: Moxibustion versus DS among patients with KOA
Outcomes 1 2
No. of studies (No. of knees diagnosed as OA) 5 (480) 2 (179)
No. of event/ No. of participants Intervention 227/ 242 81/ 91
Comparator 199/ 238 72/ 89
Pooled RRI (95% CI) 11% (4% to 81%) 10% (-3% to 24%)
Overall quality of evidence* Low Low
Outcomes 3
No. of studies (No. of knees diagnosed as OA) 2 (218)
Mean score / No. of participants Intervention 2.17/ 110
Comparator 2.01/ 108
Pooled WMD
(95% CI)
0.16 (-0.11 to 0.44)
Overall quality of evidence* Low
Keys: RRI = relative risk increase; WMD = weighted mean difference; CI = confidence interval.
Conclusion
Benefits
Compared to DS, moxibustion could significantly benefit KOA patients at the end of treatment, but the effect was not sustained at 2 months’ follow-up. No significant reduction on pain level measured by NRS from baseline to the end of treatment was observed among the KOA patients. For all outcomes, the overall quality of evidence is low. Further research is likely to have an important impact on our confidence in this estimate of effect.
Harms
No adverse event was reported by the reviewers.
Link to Original Article
http://www.ncbi.nlm.nih.gov/pubmed/22461183
The synopsis is based on the following article:
Choi TY, Choi J, Kim KH, Lee MS. Moxibustion for the treatment of osteoarthritis: a systematic review and meta-analysis. Rheumatol Int. 2012 Oct;32(10):2969-78.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.