July 13, 2020

The Niche

Knoepfler lab stem cell blog

Bigger picture study casts big doubts on stem cells for knee arthritis today

knee arthritis stem cells
An x-ray of an arthritic knee

One of the most common claims made by unproven, for-profit stem cell clinics is that the stem cells they are selling can help knee arthritis and associated pain, but what is the evidence to back this up?

There are many problems with the claims of stem cells for arthritis being made across the U.S. In quite a few cases what is being sold isn’t even real stem cells. It often is an amniotic extract, which probably isn’t from actual stem cells anyway and is “dead.” But what about cases where real, live stem cells are being injected every day for knees arthritis and other kinds of joint problems?

The CIRM Blog recently covered the issue of stem cells for knee arthritis in large part inspired by a new comprehensive study that sheds major doubt on this approach. Some of the main take-homes from the study were nicely summarized by Kevin McCormack of CIRM:

“In a study presented at the Annual Meeting of the American Academy of Orthopaedic Surgeons, researchers contacted 317 clinics in the US that directly market stem cell therapies to consumers. They asked the clinics for information on the cost of the procedure and their success rate.

  • Only 65 clinics responded
  • Lowest price was $1,150
  • Highest price was $12,000,
  • Average price of $5,156.

Only 36 clinics responded with information about success rates.

  • 10 claimed between 90 and 100 percent success
  • 15 claimed 80 to 90 percent success
  • 10 claimed 70 to 80 percent
  • One said just 55 percent.

None offered any evidence based on a clinical trial that supported those claims, and there was no connection between how much they charged and how successful they claimed to be.”

Put it together and it paints a negative overall picture of the clinics in this sphere. Patients are paying around $5K for a kind of stem cell treatment where clinics are largely claiming 70-100% success, but yet have little or no evidence to back it up. The average cost data here fit well with the numbers in a poll I did about 6 months ago on this blog of what patients say they paid for stem cell therapies more generally.

McCormack has quotes both from the lead authors, Nicolas Piuzzi and George Muschler, of the study entitled, “The Stem-Cell Market for Treatment of Knee Osteoarthritis: A Patient Perspective“, which is published in Journal of Knee Surgery with some big picture perspectives and thoughts on the meaning of their work.

Basically, there’s a disconnect between the state of the clinical science in this area and what is being widely marketed for profit.  I’m not aware of massive patient side effects in this area so safety, while not assured by any means, is not perhaps the biggest issue. However, there is minimal evidence of efficacy from properly controlled studies. For instance, the authors of this study suggest potential benefit of bone marrow stem cells for knee arthritis, but although it did have a control group, it wasn’t blinded and was underpowered. Here’s a more recent, blinded study arguing for some moderate benefit, but it was underpowered as well and no benefit was seen after 12 months.

The bottom line in my view is that stem cells for arthritis from clinics directly marketing to consumers is most often going to be a big waste of money for patients. This is not to say that there’s no hope of stem cells for arthritis or specifically for knee arthritis, but caution is in order right now on this front. There needs to be more rigorous data on efficacy. I hope in the future we get that data as a field so we can have better clarity here. You can see some past posts including knee arthritis here and it’s apparent that for up to 8 years or more this issue has been percolating.

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