Public health

Assessing the efficacy of PRP currently impossible

Thursday, 5 May 2016

People with tendinopathy will continue to be offered non-evidence based treatments like plasma rich proteins until production processes for the procedure are standardised allowing high quality trials to be performed, the conference has heard.

Speaking at a session called tendon pathology: controversies in treatment Dr Bethan Richards a rheumatologist at the RPA in Sydney told delegates that despite the condition being common there was virtually no agreement on pathogenic pathways, diagnostic criteria or treatments.

As a result patients were managed in a variety of ways ranging from NSAIDS, exercise, icepacks, corticosteroids to “regenerative treatments” such as stem cells or platelet rich plasma (PRP).

Dr Richards, who is affiliated with the University of Sydney says the use of PRP is particularly concerning as it is aggressively marketed to people as a ‘cure all’ for sporting injuries despite no clear evidence of benefit beyond placebo.

Current trials addressing the use of PRP were limited by their size, the fact that they were underpowered and that the methods used to develop the PRP were not standardised.

“With such discrepancy in PRP preparation how can you possibly use current literature to assess the efficacy of PRP?” she asked.

“All these trials are going to continue and they’re not going to give us the answers until we standardize the procedure” she said.

Another hurdle with the use of PRP is that it is hard to tease out the placebo response, particularly because it is an injection, regarded as ‘natural’ and ‘high-tech’ and endorsed by elite athletes.

Yet another factor fuelling the fire was the heterogenous nature of the condition.

“It’s a bit like lupus, trying to give the same drug to a heterogenous population is never going to give us clean results,” Dr Richards said.

Some of these questions could potentially be answered through the work of the collaborative clinical trials network group ANZMUSC group, she said.

“At the moment we still don’t know how to measure things, what’s the important outcomes in these patients and we don’t have that internationally standardised, “she conceded.

“We need to develop transparent standardized reproducible treatments… only then will we have the opportunity to generate high quality adequately powered randomised controlled trials”.

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