Table 1.
Systematic reviews and meta-analysis on medical ozone in knee osteoarthritis (Anzolin and Bertol, 2018; Costa et al., 2018; Raeissadat et al., 2018; Arias-Vázquez et al., 2019; Noori-Zadeh et al., 2019; Sconza et al., 2020).
| Author (year) | Study type | Number of studies | Route of O3 application | Sample size | Findings |
|---|---|---|---|---|---|
| Anzolin and Bertol, 2018 | Systematic review | 9: 7 RCTs 1 prospective non-controlled 1 experimental pre-clinical |
8: Intra-articular gas injection 1: Rectal inssuflation |
2,175 patients 180 mice |
In 7 studies, ozone was better that placebo or othr drugs. In 2 studies, ozone was better than placebo but worse than other drugs. No reference to side effects |
| Costa et al., 2018 | Systematic review | 6: Not detailed |
Intra-articular gas injection | Uknown | There is no clear recommendation for ozone treatment. Only one* moderate quality RCT. Ozone was better than placebo but similar or worse than other drugs or technique. No severe adverse reactions |
| Raeissadat et al., 2018 ** | Systematic review Meta-analysis |
5 RCTs | Intra-articular gas injection | 428 patients | Ozone was significantly superior to placebo and slightly lower to other control injections with non-significant difference. Only one* moderate quality RCT Side affects rate similar to control group. No severe adverse reactions observed |
| Arias-Vázquez et al., 2019 ** | Systematic review | 10 RCTs | Intra-articular gas injection | 781 patients | Ozone was significantly superior to placebo and similar to other control injections with non-significant difference. Only two* moderate quality RCT Side affects rate similar to control group. No severe adverse reactions observed |
| Noori-Zadeh et al., 2019 ** | Systematic review Meta-analysis |
10 RCTs | Intra-articular gas injection | 419 patients | Ozone was significantly superior to placebo and similar to other control injections with non-significant difference Only two* moderate quality RCT No reference to side effects |
| Sconza et al., 2020 ** | Systematic review | 11 RCTs | Intra-articular gas injection | 858 patients | Ozone was significantly superior to placebo and similar to other control injections with non-significant difference Only two* moderate quality RCT No severe adverse reactions observed |
RCT, randomized control trial.
*
RCT 1+ according GRADE classification (https://www.gradeworkinggroup.org/).
**
Moderate quality systematic review/meta-analysis according SIGN cheklist (https://www.sign.ac.uk/what-we-do/methodology/checklists/).