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Background <p>Osteoarthritis (OA) is a degenerative joint disease, which is accompanied by chronic pain and functional impairment, especially among the elderly population. Transdermal drug delivery offers a non-invasive option for managing OA. Our study assesses the relative effectiveness and safety of transdermal Buprenorphine compared to Diclofenac patches in the treatment of knee OA.</p> Research design and methods <p>A randomized controlled trial was performed in 152 patients with radiographically confirmed Grade I/II knee OA and with an age of 50 years and above. The participants were divided into two groups: Group A (transdermal buprenorphine) and Group B (transdermal diclofenac) as the treatment options to be used within 4 weeks. The Numeric Rating Scale (NRS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Lequesne Index were used to measure pain intensity, functional status, and disease severity, respectively. Network pharmacology analysis was also used to examine additional interactions such as safety, treatment compliance and molecular interactions.</p> Results <p>Both treatments reduced pain significantly as well as improved functional outcomes. Nevertheless, buprenorphine had a higher clinical efficacy with higher reductions in NRS scores (7.72 to 2.81 vs. 7.68 to 3.23), WOMAC total scores (71.5 to 31.8 vs. 74.0 to 45.6), and Lequesne Index values (17.4, to 5.87 vs. 17.3, to 8.42) than diclofenac. Network pharmacology analysis revealed that buprenorphine modulates 25 genes related to OA, while diclofenac affects 20 genes, suggesting that Buprenorphine may have a wider range of benefits. Both treatments demonstrated excellent tolerability.</p> Conclusions <p>Transdermal buprenorphine was found to have better short-term analgesic and functional advantages than transdermal diclofenac in early-stage knee OA. Its high tolerability, once-weekly topography and broad-spectrum interactions with its molecular targets justify its possible use in the treatment of a discrete group of patients, specifically older healthcare individuals or those intolerant to NSAIDs.</p>

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Comparative efficacy of transdermal buprenorphine versus diclofenac in the management of knee osteoarthritis: a randomized controlled trial with network pharmacology insights

  • 期刊论文

  • 发表日期：

    2026年3月2日

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  • Abhay Singh,
  • Sneha Yadav,
  • Anil Kumar Gulia,
  • Shivani Singh,
  • Sanjeev Bansal,
  • Prem Shankar Gupta,
  • Soniya Rani

摘要

Background

Osteoarthritis (OA) is a degenerative joint disease, which is accompanied by chronic pain and functional impairment, especially among the elderly population. Transdermal drug delivery offers a non-invasive option for managing OA. Our study assesses the relative effectiveness and safety of transdermal Buprenorphine compared to Diclofenac patches in the treatment of knee OA.

Research design and methods

A randomized controlled trial was performed in 152 patients with radiographically confirmed Grade I/II knee OA and with an age of 50 years and above. The participants were divided into two groups: Group A (transdermal buprenorphine) and Group B (transdermal diclofenac) as the treatment options to be used within 4 weeks. The Numeric Rating Scale (NRS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Lequesne Index were used to measure pain intensity, functional status, and disease severity, respectively. Network pharmacology analysis was also used to examine additional interactions such as safety, treatment compliance and molecular interactions.

Results

Both treatments reduced pain significantly as well as improved functional outcomes. Nevertheless, buprenorphine had a higher clinical efficacy with higher reductions in NRS scores (7.72 to 2.81 vs. 7.68 to 3.23), WOMAC total scores (71.5 to 31.8 vs. 74.0 to 45.6), and Lequesne Index values (17.4, to 5.87 vs. 17.3, to 8.42) than diclofenac. Network pharmacology analysis revealed that buprenorphine modulates 25 genes related to OA, while diclofenac affects 20 genes, suggesting that Buprenorphine may have a wider range of benefits. Both treatments demonstrated excellent tolerability.

Conclusions

Transdermal buprenorphine was found to have better short-term analgesic and functional advantages than transdermal diclofenac in early-stage knee OA. Its high tolerability, once-weekly topography and broad-spectrum interactions with its molecular targets justify its possible use in the treatment of a discrete group of patients, specifically older healthcare individuals or those intolerant to NSAIDs.