SYSTEMATIC REVIEW article
Front. Med.
Sec. Rheumatology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1652732
The effect of metformin in clinical studies on knee osteoarthritis: An updated systematic review and meta-analysis
Provisionally accepted
- 1Sheng Jing Hospital Affiliated, China Medical University, Shenyang, China
- 2Liaoning Cancer Hospital and Institute, Shenyang, China
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Objectives: Metformin is regarded as a potential drug for the treatment of knee osteoarthritis (KOA), but its efficacy remains unclear. This systematic review and meta-analysis aims to evaluate the efficacy of metformin in the treatment of KOA. Methods: According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched three literature databases, including PubMed, Web of Science and EMBASE, and conducted a systematic review and meta-analysis of randomized controlled trials and cohort studies up to April 1, 2025, studies evaluating the use of metformin in the treatment of KOA were included. Hazard ratio (RR), standard mean difference (SMD), and the corresponding 95% confidence interval (CI) were used as aggregated statistics. This systematic review is registered on RROSPERO(CRD420251026750). Results: A total of 6 eligible studies included 4628 patients (1489 patients use metformin versus 3139 patients non-use). The main observation outcome was the score of the pain scale (WOMAC, KOOS, VAS, etc.) of the knee joint and the incidence of total knee arthroplasty (TKA) is a secondary outcome. Analysis of the included population the included population reveals that the BMI levels of all individuals were at the overweight range. In this situation, the comprehensive results show that regardless of different conventional treatment methods, courses of treatment and doses, combined metformin treatment in the incidence of joint replacement (RR = 0.65, 95% CI [0.54, 0.77], p < 0.00001) and knee pain scores (SMD = -0.47, 95% CI [-0.84, -0.11], p = 0.01), it was superior to the control group treatment. Conclusions: The research results show that metformin can relieve the pain of KOA with high BMI and reduce the possibility of joint replacement. However, due to the less of randomized controlled trials (RCTs), clinicians should be fully cautious when using it.
Keywords: knee osteoarthritis, Metformin, Total knee arthroplasty, Pain Management, Meta-analysis
Received: 24 Jun 2025; Accepted: 02 Oct 2025.
Copyright: © 2025 Guo, Xie, Liu, Hou, Tan, Miao, Xu and Tian. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Ying Xu, xuy5@sj-hospital.org
Ye Tian, tiany3@sj-hospital.org
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.