1
|
Cui X, Fu Z, Wang H, Yu W, Han F. Cloning and characterization of a hyaluronate lyase EsHyl8 from Escherichia sp. A99. Protein Expr Purif 2024; 223:106551. [PMID: 38997076 DOI: 10.1016/j.pep.2024.106551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 06/30/2024] [Accepted: 07/09/2024] [Indexed: 07/14/2024]
Abstract
Hyaluronidase, an enzyme that degrades hyaluronic acid (HA), is utilized in clinical settings to facilitate drug diffusion, manage extravasation, and address injection-related complications linked to HA-based fillers. In this study, a novel hyaluronate lyase EsHyl8 was cloned, expressed, and characterized from Escherichia sp. A99 of human intestinal origin. This lyase belongs to polysaccharide lyase (PL) family 8, and showed specific activity towards HA. EsHyl8 exhibited optimal degradation at 40 °C and pH 6.0. EsHyl8 exhibited a high activity of 376.32 U/mg among hyaluronidases of human gut microorganisms. EsHyl8 was stable at 37 °C and remained about 70 % of activity after incubation at 37 °C for 24 h, demonstrating excellent thermostability. The activity of EsHyl8 was inhibited by Zn2+, Cu2+, Fe3+, and SDS. EsHyl8 was an endo-type enzyme whose end-product was unsaturated disaccharide. This study enhances our understanding of hyaluronidases from human gut microorganisms.
Collapse
Affiliation(s)
- Xiuli Cui
- School of Medicine and Pharmacy, Ocean University of China, Qingdao, 266003, China; Qingdao Marine Science and Technology Center, Qingdao, 266237, China; Key Laboratory of Marine Drugs, Ministry of Education, Ocean University of China, Qingdao 266003, China; Shandong Provincial Key Laboratory of Glycoscience and Glycoengineering, Ocean University of China, Qingdao, 266003, China
| | - Zheng Fu
- School of Medicine and Pharmacy, Ocean University of China, Qingdao, 266003, China; Qingdao Marine Science and Technology Center, Qingdao, 266237, China; Key Laboratory of Marine Drugs, Ministry of Education, Ocean University of China, Qingdao 266003, China; Shandong Provincial Key Laboratory of Glycoscience and Glycoengineering, Ocean University of China, Qingdao, 266003, China
| | - Hainan Wang
- School of Medicine and Pharmacy, Ocean University of China, Qingdao, 266003, China; Qingdao Marine Science and Technology Center, Qingdao, 266237, China; Key Laboratory of Marine Drugs, Ministry of Education, Ocean University of China, Qingdao 266003, China; Shandong Provincial Key Laboratory of Glycoscience and Glycoengineering, Ocean University of China, Qingdao, 266003, China
| | - Wengong Yu
- School of Medicine and Pharmacy, Ocean University of China, Qingdao, 266003, China; Qingdao Marine Science and Technology Center, Qingdao, 266237, China; Key Laboratory of Marine Drugs, Ministry of Education, Ocean University of China, Qingdao 266003, China; Shandong Provincial Key Laboratory of Glycoscience and Glycoengineering, Ocean University of China, Qingdao, 266003, China
| | - Feng Han
- School of Medicine and Pharmacy, Ocean University of China, Qingdao, 266003, China; Qingdao Marine Science and Technology Center, Qingdao, 266237, China; Key Laboratory of Marine Drugs, Ministry of Education, Ocean University of China, Qingdao 266003, China; Shandong Provincial Key Laboratory of Glycoscience and Glycoengineering, Ocean University of China, Qingdao, 266003, China.
| |
Collapse
|
2
|
Rohila A, Shukla R. Recent advancements in microspheres mediated targeted delivery for therapeutic interventions in osteoarthritis. J Microencapsul 2024; 41:434-455. [PMID: 38967562 DOI: 10.1080/02652048.2024.2373723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 06/25/2024] [Indexed: 07/06/2024]
Abstract
Osteoarthritis (OA), affecting around 240 million people globally is a major threat. Currently, available drugs only treat the symptoms of OA; they cannot reverse the disease's progression. The delivery of drugs to afflicted joints is challenging because of poor vasculature of articular cartilage results in their less bioavailability and quick elimination from the joints. Recently approved drugs such as KGN and IL-1 receptor antagonists also encounter challenges because of inadequate formulations. Therefore, microspheres could be a potential player for the intervention of OA owing to its excellent physicochemical properties. This review primarily focuses on microspheres of distinct biomaterials acting as cargo for drugs and biologicals via different delivery routes in the effective management of OA. Microspheres can improve the efficacy of therapeutics by targeting strategies at specific body locations. This review also highlights clinical trials conducted in the last few decades.
Collapse
Affiliation(s)
- Ayush Rohila
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research-Raebareli, Lucknow, India
| | - Rahul Shukla
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research-Raebareli, Lucknow, India
| |
Collapse
|
3
|
Vishwanath K, McClure SR, Bonassar LJ. Heterogeneous distribution of viscosupplements in vivo is correlated to ex vivo frictional properties of equine cartilage. J Biomed Mater Res A 2024. [PMID: 38923105 DOI: 10.1002/jbm.a.37766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 06/03/2024] [Accepted: 06/08/2024] [Indexed: 06/28/2024]
Abstract
Intra-articular injections of hyaluronic acid (HA) are the cornerstone of osteoarthritis (OA) treatments. However, the mechanism of action and efficacy of HA viscosupplementation are debated. As such, there has been recent interest in developing synthetic viscosupplements. Recently, a synthetic 4 wt% polyacrylamide (pAAm) hydrogel was shown to effectively lubricate and bind to the surface of cartilage in vitro. However, its ability to localize to cartilage and alter the tribological properties of the tissue in a live articulating large animal joint is not known. The goal of this study was to quantify the distribution and extent of localization of pAAm in the equine metacarpophalangeal or metatarsophalangeal joint (fetlock joint), and determine whether preferential localization of pAAm influences the tribological properties of the tissue. An established planar fluorescence imaging technique was used to visualize and quantify the distribution of fluorescently labeled pAAm within the joint. While the pAAm hydrogel was present on all surfaces, it was not uniformly distributed, with more material present near the site of the injection. The lubricating ability of the cartilage in the joint was then assessed using a custom tribometer across two orders of magnitude of sliding speed in healthy synovial fluid. Cartilage regions with a greater coverage of pAAm, that is, higher fluorescent intensities, exhibited friction coefficients nearly 2-fold lower than regions with lesser pAAm (Rrm = -0.59, p < 0.001). Collectively, the findings from this study indicate that intra-articular viscosupplement injections are not evenly distributed inside a joint, and the tribological outcomes of these materials is strongly determined by the ability of the material to localize to the articulating surfaces in the joint.
Collapse
Affiliation(s)
- Karan Vishwanath
- Department of Materials Science and Engineering, Cornell University, Ithaca, New York, USA
| | | | - Lawrence J Bonassar
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, New York, USA
| |
Collapse
|
4
|
Arias-Vázquez PI. Intra-articular Injections for Treating Knee Osteoarthritis: A Classification According to Their Mechanism of Action. J Clin Rheumatol 2024; 30:168-174. [PMID: 38595298 DOI: 10.1097/rhu.0000000000002080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Affiliation(s)
- Pedro Iván Arias-Vázquez
- From the MD Rehabilitation Medicine, Sports Medicine, Department of Rehabilitation, Universidad Juárez Autónoma de Tabasco, Comalcalco, México
| |
Collapse
|
5
|
Chudzińska J, Wawrzyńczak A, Feliczak-Guzik A. Microneedles Based on a Biodegradable Polymer-Hyaluronic Acid. Polymers (Basel) 2024; 16:1396. [PMID: 38794589 PMCID: PMC11124840 DOI: 10.3390/polym16101396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
Transdermal transport can be challenging due to the difficulty in diffusing active substances through the outermost layer of the epidermis, as the primary function of the skin is to protect against the entry of exogenous compounds into the body. In addition, penetration of the epidermis for substances hydrophilic in nature and particles larger than 500 Da is highly limited due to the physiological properties and non-polar nature of its outermost layer, namely the stratum corneum. A solution to this problem can be the use of microneedles, which "bypass" the problematic epidermal layer by dispensing the active substance directly into the deeper layers of the skin. Microneedles can be obtained with various materials and come in different types. Of special interest are carriers based on biodegradable and biocompatible polymers, such as polysaccharides. Therefore, this paper reviews the latest literature on methods to obtain hyaluronic acid-based microneedles. It focuses on the current advancements in this field and consequently provides an opportunity to guide future research in this area.
Collapse
Affiliation(s)
| | - Agata Wawrzyńczak
- Faculty of Chemistry, Adam Mickiewicz University in Poznań, Uniwersytetu Poznańskiego 8, 61-614 Poznań, Poland; (J.C.); (A.F.-G.)
| | | |
Collapse
|
6
|
Roda A, Paiva A, Rita C Duarte A. A Low Transition Temperature Mixture-based viscosupplementation complemented with celecoxib for osteoarthritis treatment. Int J Pharm 2024; 656:124088. [PMID: 38582102 DOI: 10.1016/j.ijpharm.2024.124088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/08/2024]
Abstract
Viscosupplementation consists of hyaluronic acid (HA) intra-articular injections, commonly applied for osteoarthritis treatment while non-steroidal anti-inflammatory drugs (NSAIDs) are widely administered for pain relief. Here, HA and a NSAID (celecoxib) were combined in a formulation based on a low transition temperature mixture (LTTM) of glycerol:sorbitol, reported to increase celecoxib's solubility, thus rendering a potential alternative viscosupplement envisioning enhanced therapeutic efficiency. The inclusion of glucosamine, a cartilage precursor, was also studied. The developed formulations were assessed in terms of rheological properties, crucial for viscosupplementation: the parameters of crossover frequency, storage (G') and loss (G'') moduli, zero-shear-rate viscosity, stable viscosity across temperatures, and shear thinning behaviour, support viscoelastic properties suitable for viscosupplementation. Additionally, the gels biocompatibility was confirmed in chondrogenic cells (ATDC5). Regarding drug release studies, high and low clearance scenarios demonstrated an increased celecoxib (CEX) release from the gel (6 to 73-fold), compared to dissolution in PBS. The low clearance setup presented the highest and most sustained CEX release, highlighting the importance of the gel structure in CEX delivery. NMR stability studies over time demonstrated the LTTM+HA+CEX (GHA+CEX) gel as viable candidate for further in vivo evaluation. In sum, the features of GHA+CEX support its potential use as alternative viscosupplement.
Collapse
Affiliation(s)
- Ana Roda
- LAQV-REQUIMTE, Chemistry Department, NOVA School of Science and Technology, Caparica, 2829-516, Portugal.
| | - Alexandre Paiva
- LAQV-REQUIMTE, Chemistry Department, NOVA School of Science and Technology, Caparica, 2829-516, Portugal
| | - Ana Rita C Duarte
- LAQV-REQUIMTE, Chemistry Department, NOVA School of Science and Technology, Caparica, 2829-516, Portugal.
| |
Collapse
|
7
|
Langworthy M, Lascarides P, Ngai W, Steele K, Huang Y. Three once-weekly intra-articular injections of Hylan G-F 20 significantly improve pain relief compared with placebo in patients with chronic idiopathic knee osteoarthritis: a single-centre, evaluator-blinded and patient-blinded, randomized controlled trial. Drugs Context 2024; 13:2023-11-3. [PMID: 38601838 PMCID: PMC11006243 DOI: 10.7573/dic.2023-11-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/06/2024] [Indexed: 04/12/2024] Open
Abstract
Background Clinical trials on the use of viscosupplementation with hyaluronic acid (HA) in patients with knee osteoarthritis (KOA) are inconsistent, making it challenging to determine its value in clinical practice. One issue is the availability of various HA products on the market; differences in their chemical features can impact patient outcomes. Herein, we assess the efficacy and safety of three once-weekly intra-articular (IA) injections of Hylan G-F 20, a high-molecular-weight and highly crosslinked HA product, in patients with KOA. We hypothesized that Hylan G-F 20 would provide significant pain relief with no increased safety risk compared with IA saline (placebo). Methods This was a 26-week, patient-blinded and evaluator-blinded, single-centre, randomized placebo- controlled trial. Men or women ≥18 years of age with Larsen grade II or III KOA were included. Patients received IA injections of either Hylan G-F 20 or placebo once a week for 3 weeks. The primary endpoints were the week 12 and 26 visits. Primary efficacy outcomes included visual analogue scale (VAS) pain scores, patient activity level and an overall assessment of clinical condition. Secondary outcomes included adverse events (AEs) that emerged during treatment. The primary analysis included the intention-to-treat population. An alpha level of 0.05 was used in the statistical analysis. Results Thirty patients were included in the intention-to-treat population (15 per group). All efficacy outcomes were statistically significant in favour of Hylan G-F 20, except night pain and inactivity stiffness, for both patient- assessed (all p=0.0001 at week 12) and evaluator-assessed (all p=0.0001 at week 12 and p=0.0004-0.0180 at week 26) measurements. There was also a greater proportion of symptom-free patients and those with a >50% improvement in their VAS scores, except night pain, in the Hylan G-F 20 group (p=0.001-0.003 in patient-assessed scores and p<0.0001 to 0.002 in evaluator-assessed scores at week 12). Two patients, one in each group, experienced an AE; no sequelae occurred, and no special treatment was required for either AE. No patients withdrew from the study prematurely due to an AE. Conclusion In patients with chronic idiopathic KOA, Hylan G-F 20 provides significant improvements in pain relief compared with placebo with no added safety concerns.
Collapse
Affiliation(s)
| | - Peter Lascarides
- Northwell Health, Northern Westchester Hospital, Mt Kisco, NY, USA
| | | | | | - Yili Huang
- Zucker School of Medicine at Hofstra/Northwell, Northwell Phelps Hospital, Sleepy Hollow, NY, USA
| |
Collapse
|
8
|
Dıracoglu D, Sezikli S, Dernek B, Yildirim MA, Sen EI. Different doses of hyaluronic acid injections in patients with knee osteoarthritis: A multicenter, randomized, prospective, single-blind, clinical study. J Back Musculoskelet Rehabil 2024; 37:629-639. [PMID: 38160332 DOI: 10.3233/bmr-230097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Many formulations and dosing regimens are available for hyaluronic acid (HA). OBJECTIVE To compare different doses of linear, high-molecular weight (HMW) HA injections among patients with knee osteoarthritis (OA). METHODS Hundred patients were included in this randomized, single-blinded trial and randomly divided into three HA injection groups. The first group received five weekly 20 mg HA injections, the second group received three weekly 32 mg HA injections, and the third group received a single 48 mg HA injection. Patients were evaluated at baseline, 1, 3, and 6 months after the last injection for pain, stiffness, and function using the visual analog scale (VAS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire. Quality of life, patient's global assessment, and Timed Up and Go (TUG) test scores were also evaluated. RESULTS There was significant improvement in the WOMAC, VAS-pain, quality of life, patient's global assessment, and TUG test mean scores at all follow-up time points (p< 0.001). However, the groups showed no significant differences in WOMAC, VAS-activity pain, and patient global scores at any follow-up point. CONCLUSION Intra-articular injections of different doses of linear HMW HA can improve pain, stiffness, function, and quality of life in patients suffering from knee OA over a six-month period.
Collapse
Affiliation(s)
- Demirhan Dıracoglu
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Selim Sezikli
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Bahar Dernek
- Istanbul Physical Medicine and Rehabilitation Education Research Hospital, Department of Physical Medicine and Rehabilitation, University of Health Sciences, Istanbul, Turkey
| | - Mustafa Aziz Yildirim
- Department of Physical Medicine and Rehabilitation, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Ekin Ilke Sen
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| |
Collapse
|
9
|
Chevalier X, Sheehan B. Predictors of Clinical Benefit with Intra-articular Hyaluronic Acid in Patients with Knee Osteoarthritis - A Narrative Review. Curr Rheumatol Rev 2024; 20:379-387. [PMID: 38243964 PMCID: PMC11275314 DOI: 10.2174/0115733971274662240108074038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/21/2023] [Accepted: 12/13/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND There is conflicting evidence regarding the efficacy of viscosupplementation with intra-articular hyaluronic acid injections in knee osteoarthritis. One possible explanation for the inconsistent findings on its efficacy is that only certain subpopulations of patients benefit from this therapy. OBJECTIVE The purpose of this narrative review is to succinctly summarize the existing data on the predictive factors of clinical response to intra-articular hyaluronic acid to identify the patient profile most likely to benefit from this therapy. METHODS For this narrative review, a PubMed search was conducted in January 2023, with no date limits, to identify publications reporting predictive factors of response to viscosupplementation using the following terms: hyaluronic acid OR viscosupplem* AND osteoarthritis AND knee AND predict*. Searches were limited to randomized controlled trials, systematic reviews and meta- analyses, or observational studies written in English. Other relevant references were identified by searching the references of retrieved articles. RESULTS The disease severity was found to reliably predict response to intra-articular hyaluronic acid injections; patients with less severe disease consistently had a more robust therapeutic response than those with more severe disease. Other clinical variables such as level of baseline pain did not reliably predict response. Body mass index, and possibly age, may also be independent predictors of the response. CONCLUSION A review of the existing literature suggests that patients with less severe clinical symptoms and radiological findings, who are younger, and with a lower or normal body mass index are the best candidates for intra-articular hyaluronic acid therapy.
Collapse
Affiliation(s)
- Xavier Chevalier
- Department of Rheumatology, Hôpital Henri-Mondor, Université Paris X11, Créteil, France
| | - Brendan Sheehan
- Department of Orthopaedic Surgery, Dalhousie University (Halifax), Saint John, NB, Canada
| |
Collapse
|
10
|
Ranawat A, Guo K, Phillips M, Guo A, Niazi F, Bhandari M, Waterman B. Health Economic Assessments of Hyaluronic Acid Treatments for Knee Osteoarthritis: A Systematic Review. Adv Ther 2024; 41:65-81. [PMID: 37899384 DOI: 10.1007/s12325-023-02691-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 09/19/2023] [Indexed: 10/31/2023]
Abstract
INTRODUCTION Hyaluronic acid (HA) use to treat knee osteoarthritis (OA) has been extensively investigated in the literature. There are also multiple economic assessments comparing intra-articular HAs with oral anti-inflammatory medicines and other conservative measures (NSAIDs), as well as different types and formulations of HA. Owing to the broad landscape of evidence across this area, it is important to further understand the empirical data comparing HA products, as well as the health economic implications that exist between commercially available HAs. This systematic review aims to identify and summarize the available evidence comparing commercially available HA products in the USA, as well as the health economic evidence and socioeconomic outcomes associated with HA use for knee OA. METHODS A systematic literature review within the OVID Medline, Embase, HealthStar, and Cochrane EBM HTA databases was conducted. Articles were screened for eligibility, and a qualitative summary of the findings was provided based on specific themes: (1) trials comparing the safety and/or efficacy of two or more HA products in knee OA, (2) economic/cost analyses of HA use in knee OA, and (3) studies investigating healthcare resource utilization in patients treated with HA for knee OA. RESULTS The search strategy identified 398 studies, 27 of which were deemed eligible: 21 health economic analyses with US relevance and six head-to-head trials of HA products available in the USA, cumulatively assessing 5,782,156 patients with knee OA. The evidence demonstrates a clear distinction between high and low molecular weight HAs, as both efficacy and cost analyses provided favorable results for the high molecular weight options. In all but one cost analysis, HA use was a cost-effective option when compared to routine nonoperative care, captured in administrative databases, which typically included NSAID use and/or corticosteroids. HA saw benefits in delaying the need for total knee arthroplasty (TKA), decreasing the use of rescue medication, and limiting the need for additional corticosteroid injection. The included evidence highlights that the treatment's cost-effectiveness is improved when HA is utilized in earlier stages of the disease, as opposed to when HA is reserved for late stages of knee OA. Additionally, among HAs, Bio-HA and Hylan G-F 20 evidence made up the majority of available literature with beneficial efficacy and cost outcomes. Head-to-head evidence between them indicated similar pain outcomes; however, Bio-HA required less rescue with acetaminophen and had fewer joint effusions in this comparison. CONCLUSIONS The available efficacy and safety data as well as health economic analyses on the use of HA for knee OA management suggest that there are economic benefits of this treatment option. From a healthcare system perspective, the body of HA literature summarizes favorable costs profile, decreased opioid and corticosteroid use as rescue medication, and a delay to the need for TKA in patients who have HA included in their treatment regimen.
Collapse
Affiliation(s)
- Anil Ranawat
- Department of Orthopaedics, Hospital for Special Surgery, New York, NY, USA
| | - Kaiwen Guo
- Ferring Pharmaceuticals, Inc., Parsippany, NJ, USA.
| | - Mark Phillips
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Amy Guo
- Ferring Pharmaceuticals, Inc., Parsippany, NJ, USA
| | - Faizan Niazi
- Ferring Pharmaceuticals, Inc., Parsippany, NJ, USA
| | - Mohit Bhandari
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Brian Waterman
- Department of Orthopaedics, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| |
Collapse
|
11
|
Ferkel E, Manjoo A, Martins D, Bhandari M, Sethi P, Nicholls M. Intra-articular Hyaluronic Acid Treatments for Knee Osteoarthritis: A Systematic Review of Product Properties. Cartilage 2023; 14:424-432. [PMID: 37314014 PMCID: PMC10807741 DOI: 10.1177/19476035231154530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 11/30/2022] [Accepted: 12/30/2022] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION There are many intra-articular hyaluronic acid (IA-HA) products on the market that have known intrinsic differences in molecular size, source, and structure. The current review summarizes existing evidence describing and assessing these differences, while also identifying whether these differences have an impact on clinical outcomes. METHODS This systematic review summarized all literature that specifically addresses IA-HA product differences. Included studies summarized basic science and mechanism of action comparisons of IA-HA product differences, or systematic reviews that assess differences in clinical outcomes between IA-HA product differences. RESULTS A total of 20 investigations assessed basic science differences between IA-HA products, while 20 investigations provided assessments of the clinical outcome differences between IA-HA product characteristics. The published basic science literature provided a differentiation between low molecular weight (LMW) and high molecular weight (HMW) HA with regard to changes within the synovial fluid, driven by the interactions that these molecules have with receptors in the joint space. These differences in receptor interaction manifest within clinical outcomes, as meta-analyses comparing pain relief after IA-HA suggest that pain reduction is superior in patients who receive HMW HA as opposed to LMW HA. CONCLUSION This review highlights differences between IA-HA characteristics, and how important the molecular weight, derivation of the product, and structure are to variances in reported clinical outcomes to treat osteoarthritis (OA) of the knee. HMW IA-HAs have shown greater efficacy compared to the alternative of LMW products, while avian-derived and cross-linked products have potentially demonstrated an increase in inflammatory events over non-avian-derived, non-cross-linked HAs.
Collapse
Affiliation(s)
- Eric Ferkel
- Southern California Orthopedic Institute, Los Angeles, CA, USA
| | - Ajay Manjoo
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | | | - Mohit Bhandari
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Paul Sethi
- Orthopedic & Neurosurgical Specialists, ONS Foundation, Greenwich, CT, USA
| | - Mathew Nicholls
- Virginia Mason Orthopedics & Sports Medicine, Seattle, WA, USA
| |
Collapse
|
12
|
Porcello A, Hadjab F, Ajouaou M, Philippe V, Martin R, Abdel-Sayed P, Hirt-Burri N, Scaletta C, Raffoul W, Applegate LA, Allémann E, Jordan O, Laurent A. Ex Vivo Functional Benchmarking of Hyaluronan-Based Osteoarthritis Viscosupplement Products: Comprehensive Assessment of Rheological, Lubricative, Adhesive, and Stability Attributes. Gels 2023; 9:808. [PMID: 37888381 PMCID: PMC10606320 DOI: 10.3390/gels9100808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 09/30/2023] [Accepted: 10/07/2023] [Indexed: 10/28/2023] Open
Abstract
While many injectable viscosupplementation products are available for osteoarthritis (OA) management, multiple hydrogel functional attributes may be further optimized for efficacy enhancement. The objective of this study was to functionally benchmark four commercially available hyaluronan-based viscosupplements (Ostenil, Ostenil Plus, Synvisc, and Innoryos), focusing on critical (rheological, lubricative, adhesive, and stability) attributes. Therefore, in vitro and ex vivo quantitative characterization panels (oscillatory rheology, rotational tribology, and texture analysis with bovine cartilage) were used for hydrogel product functional benchmarking, using equine synovial fluid as a biological control. Specifically, the retained experimental methodology enabled the authors to robustly assess and discuss various functional enhancement options for hyaluronan-based hydrogels (chemical cross-linking and addition of antioxidant stabilizing agents). The results showed that the Innoryos product, a niacinamide-augmented linear hyaluronan-based hydrogel, presented the best overall functional behavior in the retained experimental settings (high adhesivity and lubricity and substantial resistance to oxidative degradation). The Ostenil product was conversely shown to present less desirable functional properties for viscosupplementation compared to the other investigated products. Generally, this study confirmed the high importance of formulation development and control methodology optimization, aiming for the enhancement of novel OA-targeting product critical functional attributes and the probability of their clinical success. Overall, this work confirmed the tangible need for a comprehensive approach to hyaluronan-based viscosupplementation product functional benchmarking (product development and product selection by orthopedists) to maximize the chances of effective clinical OA management.
Collapse
Affiliation(s)
- Alexandre Porcello
- School of Pharmaceutical Sciences, University of Geneva, CH-1206 Geneva, Switzerland; (M.A.); (E.A.); (O.J.)
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, CH-1206 Geneva, Switzerland
| | - Farid Hadjab
- Development Department, Albomed GmbH, D-90592 Schwarzenbruck, Germany;
| | - Maryam Ajouaou
- School of Pharmaceutical Sciences, University of Geneva, CH-1206 Geneva, Switzerland; (M.A.); (E.A.); (O.J.)
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, CH-1206 Geneva, Switzerland
| | - Virginie Philippe
- Regenerative Therapy Unit, Lausanne University Hospital, University of Lausanne, CH-1066 Epalinges, Switzerland; (V.P.); (P.A.-S.); (N.H.-B.); (C.S.); (W.R.); (L.A.A.)
- Orthopedics and Traumatology Service, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland;
| | - Robin Martin
- Orthopedics and Traumatology Service, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland;
| | - Philippe Abdel-Sayed
- Regenerative Therapy Unit, Lausanne University Hospital, University of Lausanne, CH-1066 Epalinges, Switzerland; (V.P.); (P.A.-S.); (N.H.-B.); (C.S.); (W.R.); (L.A.A.)
- STI School of Engineering, Federal Polytechnic School of Lausanne, CH-1015 Lausanne, Switzerland
| | - Nathalie Hirt-Burri
- Regenerative Therapy Unit, Lausanne University Hospital, University of Lausanne, CH-1066 Epalinges, Switzerland; (V.P.); (P.A.-S.); (N.H.-B.); (C.S.); (W.R.); (L.A.A.)
| | - Corinne Scaletta
- Regenerative Therapy Unit, Lausanne University Hospital, University of Lausanne, CH-1066 Epalinges, Switzerland; (V.P.); (P.A.-S.); (N.H.-B.); (C.S.); (W.R.); (L.A.A.)
| | - Wassim Raffoul
- Regenerative Therapy Unit, Lausanne University Hospital, University of Lausanne, CH-1066 Epalinges, Switzerland; (V.P.); (P.A.-S.); (N.H.-B.); (C.S.); (W.R.); (L.A.A.)
| | - Lee Ann Applegate
- Regenerative Therapy Unit, Lausanne University Hospital, University of Lausanne, CH-1066 Epalinges, Switzerland; (V.P.); (P.A.-S.); (N.H.-B.); (C.S.); (W.R.); (L.A.A.)
- Center for Applied Biotechnology and Molecular Medicine, University of Zurich, CH-8057 Zurich, Switzerland
- Oxford OSCAR Suzhou Center, Oxford University, Suzhou 215123, China
| | - Eric Allémann
- School of Pharmaceutical Sciences, University of Geneva, CH-1206 Geneva, Switzerland; (M.A.); (E.A.); (O.J.)
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, CH-1206 Geneva, Switzerland
| | - Olivier Jordan
- School of Pharmaceutical Sciences, University of Geneva, CH-1206 Geneva, Switzerland; (M.A.); (E.A.); (O.J.)
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, CH-1206 Geneva, Switzerland
| | - Alexis Laurent
- Regenerative Therapy Unit, Lausanne University Hospital, University of Lausanne, CH-1066 Epalinges, Switzerland; (V.P.); (P.A.-S.); (N.H.-B.); (C.S.); (W.R.); (L.A.A.)
- Manufacturing Department, LAM Biotechnologies SA, CH-1066 Epalinges, Switzerland
| |
Collapse
|
13
|
Ossendorff R, Thimm D, Wirtz DC, Schildberg FA. Methods of Conservative Intra-Articular Treatment for Osteoarthritis of the Hip and Knee. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:575-581. [PMID: 37427991 PMCID: PMC10552632 DOI: 10.3238/arztebl.m2023.0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/13/2023] [Accepted: 06/13/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Osteoarthritis is a degenerative joint disease that is becoming increasingly common as the population ages. Conservative treatment for hip or knee osteoarthritis has been limited to pain control. Intra-articular injections for targeted local treatment have been widely used in clinical practice for many years. METHODS This review is based on publications retrieved by a selective literature search, including recent meta-analyses, systematic reviews, randomized controlled trials (RCTs), and current guidelines. RESULTS In Germany, the 12-month prevalence of osteoarthritis in adults is 17.9%. Conservative treatments are intended to alleviate symptoms and do not affect the progression of the disease. Glucocorticoids can be used to relieve otherwise intractable pain in the short term, but their prolonged use increases the risk of cartilage loss and progression of osteoarthritis. According to multiple guidelines, there is only weak evidence for the use of hyaluronic acid. Evidence does exist that high-molecular-weight hyaluronic acid may lead to better outcomes than the low-molecular-weight form. RCTs have revealed no more than short-term clinical efficacy for a variety of specific therapeutic approaches, including the use of cytokine inhibitors. Other treatments, e.g., with platelet-enriched plasma, aspirates from bone marrow or adipose tissue, or expanded mesenchymal stromal cells (MSC), have not been found to have clinically relevant long-term effects. CONCLUSION In view of the scant available evidence, further standardized RCTs will be needed to give a more comprehensive picture of the efficacy of intra-articular treatments for hip and knee osteoarthritis.
Collapse
Affiliation(s)
- Robert Ossendorff
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn
| | - Dominik Thimm
- Pharmaceutical Institute, Pharmaceutical & Medical Chemistry, Rhenish Friedrich Wilhelm University of Bonn
| | - Dieter C. Wirtz
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn
| | | |
Collapse
|
14
|
Meehan RT, Gill MT, Hoffman ED, Coeshott CM, Galvan MD, Wolf ML, Amigues IA, Kastsianok LM, Regan EA, Crooks JL, Czuczman GJ, Knight V. Ultrasound-Guided Injections of HYADD4 for Knee Osteoarthritis Improves Pain and Functional Outcomes at 3, 6, and 12 Months without Changes in Measured Synovial Fluid, Serum Collagen Biomarkers, or Most Synovial Fluid Biomarker Proteins at 3 Months. J Clin Med 2023; 12:5541. [PMID: 37685608 PMCID: PMC10488758 DOI: 10.3390/jcm12175541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/08/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Prior studies have demonstrated improved efficacy when intra-articular (IA) therapeutics are injected using ultrasound (US) guidance. The aim of this study was to determine if clinical improvement in pain and function after IA hyaluronic acid injections using US is associated with changes in SF volumes and biomarker proteins at 3 months. METHODS 49 subjects with symptomatic knee OA, BMI < 40, and KL radiographic grade II or III participated. Subjects with adequate aspirated synovial fluid (SF) volumes received two US-guided IA-HA injections of HYADD4 (24 mg/3 mL) 7 days apart. Clinical evaluations at 3, 6, and 12 months included WOMAC, VAS, PCS scores, 6 MWD, and US-measured SF depth. SF and blood were collected at 3 months and analyzed for four serum OA biomarkers and fifteen SF proteins. RESULTS Statistical differences were observed at 3, 6, and 12 months compared to baseline values, with improvements at 12 months for WOMAC scores (50%), VAS (54%), and PCS scores (24%). MMP10 levels were lower at 3 months without changes in SF volumes, serum levels of C2C, COMP, HA, CPII, or SF levels of IL-1 ra, IL-4, 6, 7, 8, 15, 18, ILGFBP-1, 3, and MMP 1, 2, 3, 8, 9. Baseline clinical features or SF biomarker protein levels did not predict responsiveness at 3 months. CONCLUSIONS Clinical improvements were observed at 12 months using US needle guidance for IA HA, whereas only one SF protein biomarker protein was different at 3 months. Larger studies are needed to identify which SF biomarkers will predict which individual OA patients will receive the greatest benefit from IA therapeutics.
Collapse
Affiliation(s)
- Richard T. Meehan
- Departments of Medicine, Clinical Labs, Radiology and Divisions of Rheumatology, Immunology/Complement Labs, and Biostatistics and Bioinformatics, National Jewish Health, Denver, CO 80206, USA; (M.T.G.); (E.D.H.); (C.M.C.); (M.D.G.); (M.L.W.); (I.A.A.); (E.A.R.); (J.L.C.); (G.J.C.)
| | - Mary T. Gill
- Departments of Medicine, Clinical Labs, Radiology and Divisions of Rheumatology, Immunology/Complement Labs, and Biostatistics and Bioinformatics, National Jewish Health, Denver, CO 80206, USA; (M.T.G.); (E.D.H.); (C.M.C.); (M.D.G.); (M.L.W.); (I.A.A.); (E.A.R.); (J.L.C.); (G.J.C.)
| | - Eric D. Hoffman
- Departments of Medicine, Clinical Labs, Radiology and Divisions of Rheumatology, Immunology/Complement Labs, and Biostatistics and Bioinformatics, National Jewish Health, Denver, CO 80206, USA; (M.T.G.); (E.D.H.); (C.M.C.); (M.D.G.); (M.L.W.); (I.A.A.); (E.A.R.); (J.L.C.); (G.J.C.)
| | - Claire M. Coeshott
- Departments of Medicine, Clinical Labs, Radiology and Divisions of Rheumatology, Immunology/Complement Labs, and Biostatistics and Bioinformatics, National Jewish Health, Denver, CO 80206, USA; (M.T.G.); (E.D.H.); (C.M.C.); (M.D.G.); (M.L.W.); (I.A.A.); (E.A.R.); (J.L.C.); (G.J.C.)
| | - Manuel D. Galvan
- Departments of Medicine, Clinical Labs, Radiology and Divisions of Rheumatology, Immunology/Complement Labs, and Biostatistics and Bioinformatics, National Jewish Health, Denver, CO 80206, USA; (M.T.G.); (E.D.H.); (C.M.C.); (M.D.G.); (M.L.W.); (I.A.A.); (E.A.R.); (J.L.C.); (G.J.C.)
| | - Molly L. Wolf
- Departments of Medicine, Clinical Labs, Radiology and Divisions of Rheumatology, Immunology/Complement Labs, and Biostatistics and Bioinformatics, National Jewish Health, Denver, CO 80206, USA; (M.T.G.); (E.D.H.); (C.M.C.); (M.D.G.); (M.L.W.); (I.A.A.); (E.A.R.); (J.L.C.); (G.J.C.)
| | - Isabelle A. Amigues
- Departments of Medicine, Clinical Labs, Radiology and Divisions of Rheumatology, Immunology/Complement Labs, and Biostatistics and Bioinformatics, National Jewish Health, Denver, CO 80206, USA; (M.T.G.); (E.D.H.); (C.M.C.); (M.D.G.); (M.L.W.); (I.A.A.); (E.A.R.); (J.L.C.); (G.J.C.)
| | - Liudmila M. Kastsianok
- Departments of Medicine, Clinical Labs, Radiology and Divisions of Rheumatology, Immunology/Complement Labs, and Biostatistics and Bioinformatics, National Jewish Health, Denver, CO 80206, USA; (M.T.G.); (E.D.H.); (C.M.C.); (M.D.G.); (M.L.W.); (I.A.A.); (E.A.R.); (J.L.C.); (G.J.C.)
| | - Elizabeth A. Regan
- Departments of Medicine, Clinical Labs, Radiology and Divisions of Rheumatology, Immunology/Complement Labs, and Biostatistics and Bioinformatics, National Jewish Health, Denver, CO 80206, USA; (M.T.G.); (E.D.H.); (C.M.C.); (M.D.G.); (M.L.W.); (I.A.A.); (E.A.R.); (J.L.C.); (G.J.C.)
| | - James L. Crooks
- Departments of Medicine, Clinical Labs, Radiology and Divisions of Rheumatology, Immunology/Complement Labs, and Biostatistics and Bioinformatics, National Jewish Health, Denver, CO 80206, USA; (M.T.G.); (E.D.H.); (C.M.C.); (M.D.G.); (M.L.W.); (I.A.A.); (E.A.R.); (J.L.C.); (G.J.C.)
- Department of Epidemiology, Colorado School of Public Health, CU Anschutz School of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Gregory J. Czuczman
- Departments of Medicine, Clinical Labs, Radiology and Divisions of Rheumatology, Immunology/Complement Labs, and Biostatistics and Bioinformatics, National Jewish Health, Denver, CO 80206, USA; (M.T.G.); (E.D.H.); (C.M.C.); (M.D.G.); (M.L.W.); (I.A.A.); (E.A.R.); (J.L.C.); (G.J.C.)
- Radiology Imaging Associates, Englewood, CO 80112, USA
| | - Vijaya Knight
- Department of Pediatrics, Section of Allergy and Immunology, CU Anschutz School of Medicine, University of Colorado, Aurora, CO 80045, USA;
| |
Collapse
|
15
|
Kim JG, Kim KI, Park KB, Park YG, Bae JH, Seo YJ, Seon JK, Shon OJ, Ahn JH, Wang L, Wang JH, Choi ES, Ha JK, Han HS, Moon SW. Safety and effectiveness of intra-articular injection of a highly cross-linked hyaluronic acid, LBSA0103 (Synovian): Results from a post-marketing surveillance study in South Korea. PLoS One 2023; 18:e0287222. [PMID: 37347765 PMCID: PMC10287010 DOI: 10.1371/journal.pone.0287222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/01/2023] [Indexed: 06/24/2023] Open
Abstract
This study aimed to assess the safety and effectiveness of the highly cross-linked hyaluronic acid-LBSA0103-in patients with knee osteoarthritis (OA) as per the prescribing information (PI) in South Korea. A total of 3,140 subjects aged ≥19 years were enrolled in this post-marketing surveillance (PMS) study from 2013 to 2019. The subjects received one or two injections of LBSA0103. The median duration of follow-up was 308 days. Adverse events (AEs), adverse drug reactions (ADRs), and serious AEs (SAEs) were monitored. Effectiveness was evaluated based on an index of effectiveness in accordance with the guidelines established by the Ministry of Food and Drug Safety and using a 100-mm visual analog scale (VAS) for weight-bearing pain. Overall, 250 subjects (7.96%) experienced 292 AEs and of these, unexpected AEs occurred in 114 subjects (3.63% [95% CI: 3.00-4.35]). Injection site pain was the most frequent AE reported by 81 subjects (2.58% [95% confidence intervals (CI): 2.05-3.20]). One hundred subjects experienced 108 ADRs (3.18% [95% CI: 2.60, 3.86]) and 15 unexpected ADRs were experienced by 13 subjects (0.41% [95% CI: 0.22-0.71]). Seventeen subjects experienced 22 SAEs (0.54% [95% CI: 0.32-0.87]) during the entire PMS period, and all were considered "unlikely" related to the study drug. Most AEs were mild in terms of severity and resolved during the study period. LBSA0103 was also effective in relieving symptomatic pain in knee OA patients. The condition in more than 80% of the subjects was considered to be improved when assessed by the investigators. LBSA0103 resulted in a significant reduction in the mean VAS score at 12 weeks after the first and second injections (24.79 (± 20.55) mm and 17.63 (±12.31) mm, respectively; p<0.0001). In conclusion, LBSA0103, used for the treatment of knee OA in a real-world setting, was well tolerated, with an acceptable safety profile and consistent therapeutic effect.
Collapse
Affiliation(s)
- Jae Gyoon Kim
- Department of Orthopedic Surgery, Korea University College of Medicine Ansan Hospital, Gyeongki-do, Republic of Korea
| | - Kang-Il Kim
- Department of Orthopedic Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Ki-Bong Park
- Department of Orthopedic Surgery, Good Samsun Hospital, Busan, Republic of Korea
| | - Yong-Geun Park
- Department of Orthopedic Surgery, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Ji Hoon Bae
- Department of Orthopedic Surgery, Korea University College of Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Young-Jin Seo
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Republic of Korea
| | - Jong-Keun Seon
- Department of Orthopedic Surgery, Chonnam National University Hwasun Hospital and Medical School, Jeonnam, Republic of Korea
| | - Oog Jin Shon
- Department of Orthopedic Surgery, School of Medicine, Yeungnam University Hospital, Daegu, Republic of Korea
| | - Ji Hyun Ahn
- Department of Orthopedic Surgery, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Lih Wang
- Department of Orthopedic Surgery, Dong-A University College of Medicine, Dong-A University Hospital, Busan, Korea
| | - Joon-Ho Wang
- Department of Orthopedic Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eui Sung Choi
- Department of Orthopedic Surgery, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Jeong-Ku Ha
- Department of Orthopedic Surgery, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Hyuk-Soo Han
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang Won Moon
- Department of Orthopedic Surgery, Inje University Haeundae Paik Hospital, Busan, Korea
| |
Collapse
|
16
|
Westhauser F, Doll J, Bangert Y, Walker T, Reiner T, Renkawitz T. [Treatment of unicompartmental osteoarthritis of the knee]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023:10.1007/s00132-023-04391-5. [PMID: 37318534 DOI: 10.1007/s00132-023-04391-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 06/16/2023]
Abstract
Osteoarthritis of the knee is one of the most important degenerative joint diseases in the clinical routine. The treatment of knee osteoarthritis is not only based on the stage, symptoms and duration of the joint disease, but also depends on the existing arthrosis pattern. In the case of unicompartmental arthrosis, damage typical for osteoarthritis is limited to just one joint compartment. Both the conservative and the surgical treatment of unicompartmental osteoarthritis of the knee have to respect the individual characteristics of the respective forms of osteoarthritis. In the context of this manuscript, the genesis, the diagnostics and the guideline-based stage-adapted conservative and operative treatment of unicompartmental osteoarthritis of the knee are addressed.
Collapse
Affiliation(s)
- F Westhauser
- Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - J Doll
- Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - Y Bangert
- Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - T Walker
- Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - T Reiner
- Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - T Renkawitz
- Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland.
| |
Collapse
|
17
|
Huang Y, Lascarides P, Ngai W, Steele K, Hummer CD. Three Weekly Intra-Articular Injections of Hylan G-F 20 vs Arthrocentesis in Patients with Chronic Idiopathic Knee Osteoarthritis: A Multicenter, Evaluator- and Patient-Blinded, Randomized Controlled Trial. CURRENT THERAPEUTIC RESEARCH 2023; 99:100707. [PMID: 37408828 PMCID: PMC10319210 DOI: 10.1016/j.curtheres.2023.100707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 05/22/2023] [Indexed: 07/07/2023]
Abstract
Background Knee osteoarthritis is a leading cause of disability worldwide. Symptoms can vary over time, leading to episodes of worsened symptoms known as flares. Intra-articular injection of hyaluronic acid has demonstrated long-term symptomatic relief in the broader knee osteoarthritis population, although its use in the flare population has not been extensively examined. Objective To assess the efficacy and safety of 3 once-weekly intra-articular injections of hylan G-F 20 (as single and repeat courses) in patients with chronic knee osteoarthritis, including a subpopulation that experienced flare. Methods Prospective randomized controlled, evaluator- and patient-blinded, multicenter trial with 2 phases: hylan G-F 20 vs arthrocentesis only (control) and 2 courses vs single-course hylan G-F 20. Primary outcomes were visual analog scale (0-100 mm) pain scores. Secondary outcomes included safety and synovial fluid analysis. Results Ninety-four patients (104 knees) were enrolled in Phase I, with 31 knees representing flare patients. Seventy-six patients (82 knees) were enrolled in Phase II. Long-term follow-up was 26 to 34 weeks. In flare patients, hylan G-F 20 showed significantly more improvement than the controls for all primary outcomes except pain at night (P = 0.063). Both 1 and 2 courses of hylan G-F 20 showed significant improvements from baseline for primary outcomes with no differences in efficacy between groups in the intention-to-treat population at the end of Phase II. Two courses of hylan G-F 20 showed better improvement in pain with motion (P = 0.0471) at long-term follow-up. No general side effects were reported, and local reactions (pain/swelling of the injected joint) resolved within 1 to 2 weeks. Hylan G-F 20 was also associated with reduced effusion volume and protein concentration. Conclusions Hylan G-F 20 significantly improves pain scores vs arthrocentesis in flare patients with no safety concerns. A repeat course of hylan G-F 20 was found to be well tolerated and efficacious.
Collapse
Affiliation(s)
- Yili Huang
- Zucker School of Medicine at Hofstra/Northwell, Northwell Phelps Hospital, Sleepy Hollow, New York
| | - Peter Lascarides
- Northwell Health, Northern Westchester Hospital, Mount Kisco, New York
| | | | | | | |
Collapse
|
18
|
Blicharski T, Łukasik P, Plebanski R, Żęgota Z, Szuścik M, Moster E, Pavelka K, Jeon S, Park SL. Efficacy and Safety of Intra-Articular Cross-Linked Sodium Hyaluronate for the Treatment of Knee Osteoarthritis: A Prospective, Active-Controlled, Randomized, Parallel-Group, Double-Blind, Multicenter Study. J Clin Med 2023; 12:jcm12082982. [PMID: 37109318 PMCID: PMC10145240 DOI: 10.3390/jcm12082982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
The safety and efficacy of Hyruan ONE (test product), an intra-articular cross-linked sodium hyaluronate injection, to treat mild-to-moderate knee osteoarthritis was compared with that of Durolane (comparator) in a prospective, active-controlled, parallel-group, double-blind (masked-observed), multicenter non-inferiority study. European patients (n = 284) were randomized 1:1 (test product:comparator) and received one injection of cross-linked hyaluronic acid (60 mg/3 mL). In total, 280 patients completed the study. The primary endpoint of mean change in Western Ontario and McMaster University (WOMAC)-Likert Pain sub-scores from baseline at week 13 revealed changes of -5.59 and -5.54 for the test and comparator groups, respectively, demonstrating non-inferiority of the test product (difference, -0.05 [95% confidence interval, -0.838 to 0.729]). Secondary endpoint results, which included changes in WOMAC-Likert Pain sub-score from baseline to 26 weeks post-injection and changes in WOMAC-Likert Total score and Physical Function and Stiffness sub-scores, changes in patients' and investigators' global assessments, use of rescue medication, and responder rates at 13 and 26 weeks post-injection were similar between the groups. Incidence of adverse events was also similar. In both groups, most treatment-emergent adverse events were mild/moderate. Hyruan ONE was non-inferior to the comparator at 13 weeks post-injection in European patients with mild-to-moderate knee osteoarthritis.
Collapse
Grants
- T.B., T.H., A.G., J.B., P.Ł., R.P., Z.Ż., M.S., E.M., K.P., and T.T. received a study grant from LG Chem, Ltd. S.J. and S.L.P. are full-time employees of LG Chem, Ltd LG Chem
Collapse
Affiliation(s)
- Tomasz Blicharski
- Clinic of Rehabilitation and Orthopedics, Medical University of Lublin, 20-090 Lublin, Poland
| | - Piotr Łukasik
- Trauma and Orthopedic Ward, NZOZ Medi-Spatz, 44-100 Gliwice, Poland
| | | | - Zbigniew Żęgota
- Specjalistyczny Osrodek Leczniczo Badawczy (Specialist Treatment and Research Center), 14-100 Ostroda, Poland
| | - Marek Szuścik
- Orthopedic Department, Rydygier's Hospital, 31-826 Krakow, Poland
| | - Erik Moster
- Rheumatic Center of Dr. Mostera, 61500 Brno, Czech Republic
| | - Karel Pavelka
- Institute of Rheumatology, 12850 Prague, Czech Republic
| | - Seonhui Jeon
- Life Sciences, LG Chem, Ltd., Seoul 07336, Republic of Korea
| | - So La Park
- Life Sciences, LG Chem, Ltd., Seoul 07336, Republic of Korea
| |
Collapse
|
19
|
Richard MJ, Driban JB, McAlindon TE. Pharmaceutical treatment of osteoarthritis. Osteoarthritis Cartilage 2023; 31:458-466. [PMID: 36414224 DOI: 10.1016/j.joca.2022.11.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/28/2022] [Accepted: 11/13/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To review the current state of pharmaceutical treatment recommendations for the management of osteoarthritis. METHOD A narrative review was drafted to describe treatment guidelines, mechanism of action, pharmacokinetics, and toxicity for nine classes of pharmaceuticals: 1) oral nonsteroidal anti-inflammatory drugs (NSAIDs), 2) topical NSAIDs, 3) COX-2 inhibitors, 4) duloxetine, 5) intra-articular corticosteroids, 6) intra-articular hyaluronic acid, 7) acetaminophen (paracetamol), 8) tramadol, and 9) capsaicin. RESULTS In general, oral and topical NSAIDs, including COX-2 inhibitors, are strongly recommended first-line treatments for osteoarthritis due to their ability to improve pain and function but are associated with increased risks in patients with certain comorbidities (e.g., heightened cardiovascular risks). Intra-articular corticosteroid injections are generally recommended for osteoarthritis management and have relatively minor adverse effects. Other treatments, such as capsaicin, tramadol, and acetaminophen, are more controversial, and many updated guidelines offer differing recommendations. CONCLUSION The pharmaceutical management of osteoarthritis is a constantly evolving field. Promising treatments are emerging, and medicines that were once considered conventional (e.g., acetaminophen) are gradually becoming less acceptable based on concerns with efficacy and safety. Clinicians need to consider the latest evidence and recommendations to make an informed decision with their patients about how to optimize treatment plans for patients with knee, hip, polyarticular, or hand osteoarthritis.
Collapse
Affiliation(s)
- M J Richard
- Division of Rheumatology, Immunology, and Allergy, Tufts Medical Center, Boston, MA, USA.
| | - J B Driban
- Division of Rheumatology, Immunology, and Allergy, Tufts Medical Center, Boston, MA, USA.
| | - T E McAlindon
- Division of Rheumatology, Immunology, and Allergy, Tufts Medical Center, Boston, MA, USA.
| |
Collapse
|
20
|
Lu KH, Lu PWA, Lin CW, Lu EWH, Yang SF. Different molecular weights of hyaluronan research in knee osteoarthritis: A state-of-the-art review. Matrix Biol 2023; 117:46-71. [PMID: 36849081 DOI: 10.1016/j.matbio.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/08/2023] [Accepted: 02/21/2023] [Indexed: 02/27/2023]
Abstract
Osteoarthritis (OA), the most common form of arthritis, is characterized by progressive cartilage destruction, concomitant adaptive osteogenesis, and loss of joint function. The progression of OA with aging is associated with a decrease in native hyaluronan (HA, hyaluronate or hyaluronic acid) with a high molecular weight (HMW) in synovial fluid and a subsequent increase in lower MW HA and fragments. As HMW HA possesses numerous biochemical and biological properties, we review new molecular insights into the potential of HA to modify OA processes. Different MWs in the formulation of products appear to have varying effects on knee OA (KOA) pain relief, improved function, and postponing surgery. In addition to the safety profile, more evidence indicates that intraarticular (IA) HA administration may be an effective option to treat KOA, with a particular emphasis on the use of HA with fewer injections of higher MW, including potential applications of HA of very HMW. We also analyzed published systemic reviews and meta-analyses of IA HA in treating KOA in order to discuss their conclusions and consensus statements. According to its MW, HA may offer a simple way to refine therapeutic information in selective KOA.
Collapse
Affiliation(s)
- Ko-Hsiu Lu
- Department of Orthopedics, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
| | | | - Chiao-Wen Lin
- Institute of Oral Sciences, Chung Shan Medical University, Taichung, Taiwan
| | - Eric Wun-Hao Lu
- Department of Mechanical Engineering, College of Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan.
| |
Collapse
|
21
|
Shikina E, Kovalevsky R, Shirkovskaya A, Toukach P. Prospective bacterial and fungal sources of hyaluronic acid: A review. Comput Struct Biotechnol J 2022; 20:6214-6236. [PMID: 36420162 PMCID: PMC9676211 DOI: 10.1016/j.csbj.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/05/2022] [Accepted: 11/05/2022] [Indexed: 11/11/2022] Open
Abstract
The unique biological and rheological properties make hyaluronic acid a sought-after material for medicine and cosmetology. Due to very high purity requirements for hyaluronic acid in medical applications, the profitability of streptococcal fermentation is reduced. Production of hyaluronic acid by recombinant systems is considered a promising alternative. Variations in combinations of expressed genes and fermentation conditions alter the yield and molecular weight of produced hyaluronic acid. This review is devoted to the current state of hyaluronic acid production by recombinant bacterial and fungal organisms.
Collapse
|
22
|
Nicholls M, Niazi F, Nelson WW, Lau E, Kurtz SM, Ong KL. Association Between Bio-Fermentation Derived Hyaluronic Acid and Healthcare Costs Following Knee Arthroplasty. CLINICOECONOMICS AND OUTCOMES RESEARCH 2022; 14:575-585. [PMID: 36065176 PMCID: PMC9440671 DOI: 10.2147/ceor.s347512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 08/13/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Mathew Nicholls
- Virginia Mason Orthopaedics and Sports Medicine, Seattle, WA, USA
| | - Faizan Niazi
- Ferring Pharmaceuticals Inc, Parsippany, NJ, USA
| | | | | | | | - Kevin L Ong
- Exponent, Inc, Philadelphia, PA, USA
- Correspondence: Kevin L Ong, Exponent, Inc, Philadelphia, PA, USA, Tel +1 215 594-8800, Email
| |
Collapse
|
23
|
Cells and material-based strategies for regenerative endodontics. Bioact Mater 2022; 14:234-249. [PMID: 35310358 PMCID: PMC8897646 DOI: 10.1016/j.bioactmat.2021.11.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 10/29/2021] [Accepted: 11/09/2021] [Indexed: 12/21/2022] Open
Abstract
<p class = "Abstract" style = "margin: 0 cm; line-height: 32px; font-size: 12 pt; font-family: "Times New Roman", serif; color: rgb(0, 0, 0); "><span lang = "EN-US">The carious process leads to inflammation of pulp tissue. Current care options include root canal treatment or apexification. These procedures, however, result in the loss of tooth vitality, sensitivity, and healing. Pulp capping and dental pulp regeneration are continually evolving techniques to regenerate pulp tissue, avoiding necrosis and loss of vitality. Many studies have successfully employed stem/progenitor cell populations, revascularization approaches, scaffolds or material-based strategies for pulp regeneration. Here we outline advantages and disadvantages of different methods and techniques which are currently being used in the field of regenerative endodontics. We also summarize recent findings on efficacious peptide-based materials which target the dental niche.<o:p></o:p></span></p> Pulp infection necessitates removal of necrotic, inflamed and infected tissue. Materials used clinically are inert (such as gutta percha, mineral trioxide aggregate). Recent developments in materials (angiogenic hydrogels, stem cell composites) have tuneable bioactivity. Dental pulp regeneration may now be possible through the use of bioactive systems, that guide regeneration.
Collapse
|
24
|
Hunt C, Provenzano DA, Eshraghi Y, Mittal N, Souza D, Buchheit T. Should intra-articular hyaluronic acid be used routinely for knee osteoarthritis pain? PM R 2022; 14:879-885. [PMID: 34837674 PMCID: PMC9970143 DOI: 10.1002/pmrj.12740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/13/2021] [Accepted: 11/11/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Christine Hunt
- Department of Pain Medicine, Mayo Clinic, Jacksonville, FL, USA 32224
| | | | - Yashar Eshraghi
- Louisiana State University School of Medicine, New Orleans, Louisiana, USA 70112,Department of Anesthesia, Interventional Pain Management, Ochsner Health System, University of Queensland Ochsner Clinical School, New Orleans, Louisiana, USA 70115
| | - Nimish Mittal
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada,Department of Anaesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Dmitri Souza
- Center for Pain Medicine, Western Reserve Hospital, Cuyahoga Falls, Ohio, USA 44233
| | - Thomas Buchheit
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA 27710,Anesthesiology Service, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA 27705
| |
Collapse
|
25
|
Kim S, Elam L, Johnson V, Hess A, Webb T, Dow S, Duerr F. Intra-Articular Injections of Allogeneic Mesenchymal Stromal Cells vs. High Molecular Weight Hyaluronic Acid in Dogs With Osteoarthritis: Exploratory Data From a Double-Blind, Randomized, Prospective Clinical Trial. Front Vet Sci 2022; 9:890704. [PMID: 35747237 PMCID: PMC9209755 DOI: 10.3389/fvets.2022.890704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 04/29/2022] [Indexed: 11/13/2022] Open
Abstract
This double-blind, randomized, prospective clinical trial was conducted to obtain exploratory data comparing the efficacy of intra-articular allogeneic mesenchymal stem/stromal cells (MSC) to high molecular weight hyaluronic acid (HA) for the treatment of pain associated with canine osteoarthritis (OA). Objective gait analysis (%Body Weight Distribution, %BWD), accelerometry, clinical metrology instruments and veterinary exams were used as outcome measures during various time points throughout the 48-week study period. Fourteen dogs with elbow or coxofemoral OA were enrolled and assigned in a 2:1 ratio to the treatment groups. Each patient received a set of two injections 4 weeks apart. Self-limiting joint flare was observed in seven patients, with six of these in the MSC group. Ten patients completed all follow-up appointments. Both treatment groups showed evidence of mild improvement following the treatment, but the results were inconsistent among the various outcome measures assessed. Overall, dogs enrolled in the HA group showed greater improvement compared to the MSC group. The primary outcome measure, %BWD, showed evidence of improvement, when compared to baseline values, at 36 weeks after injection for the HA group only (p = 0.048, estimated difference: 4.7). Similarly, when treatment groups were compared, evidence of a difference between treatment groups (with the HA-group showing greater improvement) were identified for weeks 24 and 36 (p = 0.02 and 0.01, respectively). The small sample size of this exploratory study does not allow firm conclusions. However, until studies with larger sample sizes are available, the current literature combined with our data do not support the clinical use of intra-articular MSC therapy over high molecular weight HA for the treatment of canine OA at this time.
Collapse
Affiliation(s)
- Sohyun Kim
- Department of Clinical Sciences, Colorado State University College of Veterinary Medicine and Biomedical Sciences, Fort Collins, CO, United States
| | - Lindsay Elam
- Department of Clinical Sciences, Colorado State University College of Veterinary Medicine and Biomedical Sciences, Fort Collins, CO, United States
| | - Valerie Johnson
- Department of Clinical Sciences, Colorado State University College of Veterinary Medicine and Biomedical Sciences, Fort Collins, CO, United States
| | - Ann Hess
- Department of Statistics, Colorado State University, Fort Collins, CO, United States
| | - Tracy Webb
- Department of Clinical Sciences, Colorado State University College of Veterinary Medicine and Biomedical Sciences, Fort Collins, CO, United States
| | - Steven Dow
- Department of Clinical Sciences, Colorado State University College of Veterinary Medicine and Biomedical Sciences, Fort Collins, CO, United States
| | - Felix Duerr
- Department of Clinical Sciences, Colorado State University College of Veterinary Medicine and Biomedical Sciences, Fort Collins, CO, United States
- *Correspondence: Felix Duerr
| |
Collapse
|
26
|
Calvet J, Khorsandi D, Tío L, Monfort J. Evaluation of a single-shot of a high-density viscoelastic solution of hyaluronic acid in patients with symptomatic primary knee osteoarthritis: the no-dolor study. BMC Musculoskelet Disord 2022; 23:442. [PMID: 35546401 PMCID: PMC9097347 DOI: 10.1186/s12891-022-05383-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/27/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Pronolis®HD mono 2.5% is a novel, one-shot, high-density sterile viscoelastic solution, recently available in Spain, which contains a high amount of intermediate molecular weight hyaluronic acid (HA), highly concentrated (120 mg in 4.8 mL solution: 2.5%). The objective of the study was to analyze the efficacy and safety of this treatment in symptomatic primary knee osteoarthritis (OA). METHODS This observational, prospective, multicenter, single-cohort study involved 166 patients with knee OA treated with a single-shot of Pronolis®HD mono 2.5% and followed up as many as 24 weeks. RESULTS Compared with baseline, the score of the Western Ontario and McMaster Universities Arthritis Osteoarthritis Index (WOMAC) pain subscale reduced at the 12-week visit (primary endpoint, median: 9 interquartile range [IQR]: 7-11 versus median: 4; IQR: 2-6; p < 0.001). The percentage of patients achieving > 50% improvement in the pain subscale increased progressively from 37.9% (at 2 weeks) to 66.0% (at 24 weeks). Similarly, WOMAC scores for pain on walking, stiffness subscale, and functional capacity subscale showed significant reductions at the 12-week visit which were maintained up to the 24-week visit. The EuroQol visual analog scale score increased after 12 weeks (median: 60 versus 70). The need for rescue medication (analgesics/nonsteroidal anti-inflammatory drugs) also decreased in all post-injection visits. Three patients (1.6%) reported local adverse events (joint swelling) of mild intensity. CONCLUSIONS In conclusion, a single intra-articular injection of the high-density viscoelastic gel of HA was associated with pain reduction and relief of other symptoms in patients with knee OA. TRIAL REGISTRATION ClinicalTrial# NCT04196764.
Collapse
Affiliation(s)
- Joan Calvet
- Rheumatology Department Hospital, Institutd'Investigació I InnovacióParcTaulí (I3PT), Universitari Parc Taulí, 08208, Sabadell, Spain
| | - Danial Khorsandi
- Procare Health Iberia, 08860, Castelldefels, Spain
- University of Barcelona, 08007, Barcelona, Spain
| | - Laura Tío
- IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain
| | - Jordi Monfort
- IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain.
- Rheumatology Department Hospital del Mar, 08003, Barcelona, Spain.
| |
Collapse
|
27
|
Nicholls M, Niazi F, Nelson WW, Lau E, Kurtz SM, Ong KL. Changes in prescription pain medication and intra-articular corticosteroid utilization after intra-articular bio-fermentation derived hyaluronic acid use in patients undergoing multimodal pain management. J Med Econ 2022; 25:7-13. [PMID: 34842508 DOI: 10.1080/13696998.2021.2009710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Multiple interventions may be used to treat symptomatic knee osteoarthritis (OA), but concerns have been raised about the safety and efficacy of some therapies. Clinical trials have shown that hyaluronic acid (HA) can provide pain relief up to 6 months and possibly to 12 months, while real-world data has shown that pain medication and intra-articular corticosteroid (CS) injection utilization are reduced within 6 months after HA. OBJECTIVE To examine changes in prescription pain medication and CS utilization during 1 year after multimodal therapy that included high molecular weight, bio-fermentation derived HA (Bio-HA) use for knee OA. METHODS Commercial and Medicare Supplemental claims data (IBM MarketScan Research Databases) (1 January 2012, through 31 December 2018) was used to identify unilateral Bio-HA patients using multimodal therapy (any combination of CS injection, opioids, and non-opioid pain medication). Monthly therapy utilization was compared in the 12 months after Bio-HA therapy initiation to the 4-month intra-multimodal period. RESULTS A total of 13,999 patients underwent Bio-HA therapy with concurrent multimodal therapy. The number of filled opioid prescriptions decreased from 2,913.0/month to 2,861.5/month after Bio-HA, with a reduction in mean monthly prescriptions from 0.60 to 0.43 per user (p < 0.001). A number of opioid days supplied also decreased from 48,914/month to 39,730/month, with a decrease from 10.1/month to 6.0/month per user (p < 0.001). Bio-HA patients had prescription pain medication-free days for 71% of the time post-multimodal period compared to 53% during the intra-multimodal period (p < 0.001). The proportion of patients with CS injections after Bio-HA decreased from 53.8% to 29.6% (p < 0.001). Total monthly CS injections decreased from 2,292 to 663. CONCLUSIONS Our data suggest that high molecular weight Bio-HA, as part of multimodal therapy, may be effective in providing longer-term pain relief with the reduction in pain therapy (CS injections and opioids) and increase in prescription pain medication-free days.
Collapse
Affiliation(s)
- Mathew Nicholls
- Virginia Mason Orthopaedics and Sports Medicine, Seattle, WA, USA
| | - Faizan Niazi
- Ferring Pharmaceuticals Inc, Parsippany, NJ, USA
| | | | | | | | | |
Collapse
|
28
|
Schroeder AN, Jelsing EJ. Optimizing Combination Hyaluronic Acid and Platelet-Rich Plasma Injections: Does Composition of Hyaluronic Acid Product Matter? Curr Sports Med Rep 2021; 20:233-235. [PMID: 33908906 DOI: 10.1249/jsr.0000000000000836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Allison N Schroeder
- Department of Physical Medicine, Mayo Clinic, Rochester, MN, and Rehabilitation
| | | |
Collapse
|
29
|
Concoff A, Niazi F, Farrokhyar F, Alyass A, Rosen J, Nicholls M. Delay to TKA and Costs Associated with Knee Osteoarthritis Care Using Intra-Articular Hyaluronic Acid: Analysis of an Administrative Database. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2021; 14:1179544121994092. [PMID: 33814937 PMCID: PMC7989120 DOI: 10.1177/1179544121994092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 01/19/2021] [Indexed: 01/01/2023]
Abstract
Background Total knee arthroplasty (TKA) is a surgical treatment for patients with knee osteoarthritis (KOA) that no longer experience symptom relief from non-operative or pharmacologic treatments. Non-operative KOA management aims to address patient symptoms and improve function, as well as forestall or mitigate the large costs associated with TKA. The primary objective of this study was to examine the relationship between intra-articular hyaluronic acid (IA-HA) treatment and delaying TKA in patients with KOA compared to patients not receiving IA-HA, as well as to identify differences in KOA-related costs incurred among patients who received or did not receive IA-HA. Methods This was a retrospective analysis of an administrative claims database from October 1st, 2010 through September 30th, 2015. Kaplan-Meier survival analysis was conducted to determine the TKA-free survival of patients who received IA-HA, stratified by the number of injection courses received versus those who did not receive any IA-HA. Median KOA-related costs per year were calculated for 2 comparisons: (1) patients who received IA-HA versus patients who did not receive IA-HA, among patients who eventually had TKA, and (2) patients who received IA-HA versus patients who did not receive IA-HA, among patients who did not have TKA. Results A total of 744 734 patients were included in the analysis. A delay to TKA was observed after IA-HA treatment for patients treated with IA-HA compared to those who did not receive IA-HA. At 1 year, the TKA-free survival was 85.8% (95% CI: 85.6%-86.0%) for patients who received IA-HA and 74.1% (95% CI: 74.0%-74.3%) for those who did not receive IA-HA. At 2 years, the TKA free survival was 70.8% (70.5%-71.1%) and 63.7% (63.5%-63.9%) in the 2 groups, respectively. Patients treated with multiple courses of IA-HA demonstrated an incremental increase in delay to TKA with more courses of IA-HA, suggesting that the risk of TKA over the study time period is reduced with additional IA-HA courses. The hazard ratio for the need of TKA was 0.85 (95% CI 0.84-0.86) for a single course and 0.27 (95% CI 0.25-0.28) for ⩾5 courses, both compared to the no IA-HA group. In patients that eventually had TKA, the median KOA-related costs were lower among those who received IA-HA before their TKA ($860.24, 95% CI: 446.65-1722.20), compared to those who did not receive IA-HA ($2659.49, 95% CI: 891.04-7480.38). For patients who did not have TKA, the median and interquartile range (IQR) KOA-related costs per year were similar for patients who received IA-HA compared with those who did not. Conclusion These results demonstrate that within a large cohort of KOA patients, individuals who received multiple courses of IA-HA had a progressively greater delay to TKA compared to patients who did not receive IA-HA treatment. Also, for patients who progressed to TKA, IA-HA treatment was associated with a large reduction in KOA-related healthcare costs. Based on these results, multiple, repeat courses of IA-HA may be beneficial in substantially delaying TKA in KOA patients, as well as minimizing KOA-related healthcare costs.
Collapse
Affiliation(s)
| | | | - Forough Farrokhyar
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Akram Alyass
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Jeffrey Rosen
- Department of Orthopaedics & Rehabilitation, New York Presbyterian Queens, Weill Medical College of Cornell University, New York, NY, USA
| | - Mathew Nicholls
- Virginia Mason Orthopedics and Sports Medicine, Seattle, WA, USA
| |
Collapse
|