Bayesian Network Meta-analysis On The Efficacy And Safety Of Acupuncture Intervention For Ankylosing Spondyliti

ObjectiveThis study aimed to conduct a cross-sectional comparison of the efficacy of acupuncture alone interventions for the treatment of ankylosing spondylitis.An evidence-based approach was used to summarize the available evidence on acupuncture alone interventions for ankylosing spondylitis.The different regimens without head to head comparisons were contrasted by the method of indirect comparison,thereby selecting the intervention regimen that might be superior.MethodsThis study clearly included the exclusion criteria according to the PICO S principle,systematically retrieve relevant literature databases used mesh subject headings combined with free words,and used the literature management software Noteexpress for literature dereplication and screening.The screening was divided into a title/abstract screening phase and a full-text screening phase,which was conducted back-to-back and cross checked by two investigators.After identification of included RCTs,data extraction and methodological quality assessment(risk of bias assessment)were performed by two investigators using a standard data extraction form,with disagreements during the above phases resolved through discussion or handed over by a third-party adjudication.The data analysis phase of this study was conducted in two parts,using R software based on Bayesian network meta-analysis to conduct a cross-sectional comparison of the efficacy and safety data of acupuncture alone interventions for the treatment of ankylosing spondylitis,and to rank the efficacy of different acupuncture intervention protocols.For the other outcome measures we focus on,we used Revman 5.4 software for direct comparison of different interventions.ResultsNetwork meta-analysis showed that conventional acupuncture may have better effects in increasing the effectiveness rate than sulfasalazine[RR=1.2,95%CI(1.09,1.31)]as well as sulfasalazine combined with analgesic medication[RR=1.21,95%CI(1.06,1.38)].Patients who received electroacupuncture were likely to gain less benefit in terms of increased effectiveness than those who received silver acupuncture[RR=0.77,95%CI(0.56,0.98)].Bee acupuncture may be more effective than sulfasalazine in increasing the effectiveness rate[RR=1.32,95%CI(1.03,1.78)]as well as sulfasalazine combined with analgesic drugs[RR=1.33,95%CI(1.01,1.86)].Fire needles may have a better effect than analgesics in increasing treatment efficacy[RR=1.57,95%CI(1.17,2.23)].Patients with ankylosing spondylitis may experience less benefit in terms of improved response rate when receiving sulfasalazine[RR=0.72,95%CI(0.52,0.97)]as well as sulfasalazine combined with analgesic medication[RR=0.71,95%CI(0.50,0.97)]than with internal thermal needles.Interventions efficacy effect ranking results showed that the ranking in the top three ranked were fire needles(69.21%),silver needles(26.21%),and Tongdu hot needles(17.99%).The results of the systematic review showed that patients with ankylosing spondylitis who received conventional acupuncture may be more effective in increasing their treatment response rate compared to patients who received sulfasalazine[RR=1.21,95%CI(1.11,1.31),438 subjects].Patients with ankylosing spondylitis receiving warm acupuncture may benefit more from increased effectiveness than those receiving sulfasalazine combined with analgesics as well as methotrexate[RR=1.23,95%CI(1.12,1.35),372 subjects].Internal hot needles may be more effective in reducing VAS scores in patients with ankylosing spondylitis compared to conventional acupuncture[MD=-1.75,95%CI(-2.25,-1.25),62 subjects].Patients with ankylosing spondylitis who received internal hot needles were likely to gain more benefit in reducing ESR than those who received conventional acupuncture[MD=-3.66,95%CI(-4.40,-2.92),62 subjects].Internal hot needles may be more effective than conventional acupuncture in reducing CRP in patients with ankylosing spondylitis[MD=-1.91,95%CI(-2.76,-1.06),62 subjects].Internal hot needles may be more effective in improving BASFI in patients with ankylosing spondylitis compared to conventional acupuncture[MD=-1.67,95%CI(-1.91,-1.43),62 subjects].Internal hot needles may be more effective in improving BASDAI in patients with ankylosing spondylitis compared to conventional acupuncture[MD=-1.76,95%CI(-2.01,-1.51),62 subjects].ConclusionThis study summarizes the evidence for the application of acupuncture alone in relation to the treatment of ankylosing spondylitis.Limited by the methodological quality of the original RCTs in this study,we failed to draw direct conclusions to guide clinical practice.Currently due to the lack of high-quality original studies,it is not possible to summarize the evidence for acupuncture intervention treatments contrasting with sham acupuncture or guideline recommended gold standard therapeutic agents.In addition,the field of psychological disorders occurring after illness in patients with ankylosing spondylitis is currently of less concern.