The efficacy of metformin for pain, function, and quality of life in knee osteoarthritis: A systematic review and meta-analysis
Abstract
BACKGROUND
Knee osteoarthritis (KOA) is a leading cause of disability worldwide; however current therapies offer only symptomatic relief. Metformin, a widely used antidiabetic agent, has been demonstrated to have anti-inflammatory and chondroprotective effects in preclinical models, suggesting its KOA modifying properties.
METHODS
We conducted a systematic review and meta-analysis of randomized controlled trials evaluating the effects of metformin in patients with KOA. A comprehensive search of PubMed, Embase, and Cochrane Library was performed up to May 2025. Two reviewers independently screened studies and extracted data. Statistical analyses were conducted using a random-effects model to account for between-study heterogeneity. Subgroup analyses based on formulation, treatment duration, and nonsteroidal anti-inflammatory drugs (NSAIDs) co-administration were also performed.
RESULTS
Five studies (n = 337) were included. Metformin significantly reduced pain scores (standardized mean difference [SMD] = -1.295; 95 % confidence interval [CI]: -2.063 to -0.526) and stiffness (SMD = -0.746; 95 % CI: -1.385 to -0.107), improved physical function (SMD = -2.042; 95 % CI: -3.372 to -0.712), and health-related quality of life (SMD = -1.505; 95 % CI: -2.896 to -0.115). Effects were consistent regardless of oral or topical metformin use, treatment duration, and NSAID use, although the benefits were greater when metformin was combined with NSAIDs.
CONCLUSION
While metformin demonstrated…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 337 participants or records.
Read the paper
Related studies
- Metformin as an adjuvant in breast cancer treatment
- Metformin Lysosomal Targeting: A Novel Aspect to Be Investigated for Metformin Repurposing in Neurodegenerative Diseases?
- Aberrant HSF1 signaling activation underlies metformin amelioration of myocardial infarction in mice
- Metformin induces ZFP36 by mTORC1 inhibition in cervical cancer-derived cell lines
- Protein Interaction Network for Identifying Vascular Response of Metformin (Oral Antidiabetic)
- Preventing Long COVID With Metformin
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.