1
|
Bruyère O, Reginster JY, Honvo G. Health Economic Evaluation of a High and Low Molecular Weight Hyaluronic Acid Formulation for the Treatment of Knee Osteoarthritis. Post Hoc Analyses from a Randomized Clinical Trial. Rheumatol Ther 2022; 9:1119-1128. [PMID: 35655027 PMCID: PMC9314505 DOI: 10.1007/s40744-022-00466-5] [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: 03/11/2022] [Accepted: 05/16/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION In a recent randomized placebo-controlled trial, a single intra-articular injection of a high and low molecular weight hyaluronic acid formulation (HA-HL) was shown to be effective in providing a clinically meaningful reduction in pain and functional limitation up to 24 weeks in subjects with painful knee osteoarthritis (OA). The objective of this post hoc analyses is to assess the cost-effectiveness of HA-HL compared with placebo using individual patient data from this clinical trial in a Swiss health care perspective. METHODS A total of 692 patients fulfilling the inclusion criteria were randomly allocated to HA-HL or placebo groups. Each patient received one intra-articular injection of HA-HL or placebo at baseline and was then followed-up for a total duration of 24 weeks with five follow-up visits (i.e., after weeks 1, 6, 12, 18, and 24). The EQ-5D-5L five-point verbal Likert scale was used to calculate the health utility and the related quality-adjusted life-years (QALYs) using the area-under-the-curve (AUC) method. For the costs, the price of HA-HL in Switzerland was used. The primary threshold for the incremental cost/effectiveness ratio (ICER) below which HA-HL was considered as cost-effective was 91,540 Swiss francs (CHF) per QALY (i.e., US $100,000). RESULTS No significant difference between the baseline characteristics of the HA-HL group and the placebo group was observed. With a mean ICER of 27,212 CHF per QALY (95% CI 20,135-34,289), HA-HL was considered as cost-effective compared to placebo. Sensitivity analyses (e.g., using lower or upper limit prices or using other threshold values) gave similar results, i.e., ICERs far below the threshold values of cost-effectiveness. CONCLUSIONS These results confirm the role of HA-HL as a cost-effective therapeutic option in the management of OA. However, more studies taking into account the utilization of other health care resources are needed.
Collapse
Affiliation(s)
- Olivier Bruyère
- WHO Collaborating Centre for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, CHU-Sart Tilman, Quartier Hôpital, Avenue Hippocrate 13 (Bât. B23), 4000, Liège, Belgium.
| | - Jean-Yves Reginster
- WHO Collaborating Centre for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, CHU-Sart Tilman, Quartier Hôpital, Avenue Hippocrate 13 (Bât. B23), 4000, Liège, Belgium
| | - Germain Honvo
- WHO Collaborating Centre for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, CHU-Sart Tilman, Quartier Hôpital, Avenue Hippocrate 13 (Bât. B23), 4000, Liège, Belgium
| |
Collapse
|
2
|
Shi J, Fan K, Yan L, Fan Z, Li F, Wang G, Liu H, Liu P, Yu H, Li JJ, Wang B. Cost Effectiveness of Pharmacological Management for Osteoarthritis: A Systematic Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:351-370. [PMID: 35138600 PMCID: PMC9021110 DOI: 10.1007/s40258-022-00717-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/16/2022] [Indexed: 05/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Osteoarthritis (OA) is a highly prevalent, disabling disease requiring chronic management that is associated with an enormous individual and societal burden. This systematic review provides a global cost-effectiveness evaluation of pharmacological therapy for the management of OA. METHODS Following Center for Reviews and Dissemination (CRD) guidance, a literature search strategy was undertaken using PubMed, EMBASE, Cochrane Library, Health Technology Assessment (HTA) database, and National Health Service Economic Evaluation database (NHS EED) to identify original articles containing cost-effectiveness evaluation of OA pharmacological treatment published before 4 November 2021. Risk of bias was assessed by two independent reviewers using the Joanna Briggs Institute (JBI) critical appraisal checklist for economic evaluations. The Quality of Health Economic Studies (QHES) instrument was used to assess the reporting quality of included articles. RESULTS Database searches identified 43 cost-effectiveness analysis studies (CEAs) on pharmacological management of OA that were conducted in 18 countries and four continents, with one study containing multiple continents. A total of four classes of drugs were assessed, including non-steroidal anti-inflammatory drugs (NSAIDs), opioid analgesics, symptomatic slow-acting drugs for osteoarthritis (SYSADOAs), and intra-articular (IA) injections. The methodological approaches of these studies showed substantial heterogeneity. The incremental cost-effectiveness ratios (ICERs) per quality-adjusted life-year (QALY) were (in 2021 US dollars) US$44.40 to US$307,013.56 for NSAIDS, US$11,984.84 to US$128,028.74 for opioids, US$10,930.17 to US$27,799.73 for SYSADOAs, and US$258.36 to US$58,447.97 for IA injections in different continents. The key drivers of cost effectiveness included medical resources, productivity, relative risks, and selected comparators. CONCLUSION This review showed substantial heterogeneity among studies, ranging from a finding of dominance to very high ICERs, but most studies found interventions to be cost effective based on specific ICER thresholds. Important challenges in the analysis were related to the standardization and methodological quality of studies, as well as the presentation of results.
Collapse
Affiliation(s)
- Jiayu Shi
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
- Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China
| | - Kenan Fan
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
- Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China
| | - Lei Yan
- Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China
| | - Zijuan Fan
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Fei Li
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Guishan Wang
- Department of Biochemistry and Molecular Biology, Shanxi Medical University, Taiyuan, China
| | - Haifeng Liu
- Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China
| | - Peidong Liu
- Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China
| | - Hongmei Yu
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Jiao Jiao Li
- School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, Ultimo, NSW, 2007, Australia.
| | - Bin Wang
- Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China.
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| |
Collapse
|
3
|
Vincent P. Acide hyaluronique intra-articulaire dans la gonarthrose: résultats cliniques d'une famille de produits (ARTHRUM), avec méta-analyses comparatives. Curr Ther Res Clin Exp 2021; 95:100652. [PMID: 34868410 PMCID: PMC8626835 DOI: 10.1016/j.curtheres.2021.100652] [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: 10/29/2021] [Accepted: 10/29/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction La viscosupplémentation est largement pratiquée, pour réduire la douleur dans l'arthrose (OA), par des injections intra articulaires (IA) d'acide hyaluronique (AH). En Europe, ces produits sont des dispositifs médicaux de classe III, pour lesquels la réglementation Medical Device Regulation (MDR) impose une évaluation clinique, basée sur des études spécifiques et/ou une revue bibliographique des dispositifs équivalents. L'objet de cet article est de présenter une revue comparative entre une famille de dispositifs (ARTHRUM, de LCA Pharmaceuticals, Chartres, France) et un groupe important de dispositifs AH IA présumés équivalents dont les résultats et ceux de leurs contrôles, ont fait l'objet de publications dans des journaux scientifiques. Méthodes Pour rejoindre les critères utilisés dans la plupart des études ARTHRUM, les sous-scores de l'indice Western Ontario and McMaster Universities ont été sélectionnés pour la douleur (WOMAC A), la raideur (WOMAC B) et la fonction (WOMAC C). Le critère principal était la variation du score WOMAC A depuis T0 (date d'inclusion) jusqu'à T6 (6 mois). Les autres critères WOMAC ont été évalués à T1, T3, T6 et complétés par les taux de répondeurs au traitement selon OMERACT-OARSI. Cinquante articles ont été sélectionnés, incluant des résultats portant sur plus de 12.000 patients. Ceux-ci ont été répartis en trois groupes: ARTHRUM, EQUIVALENTS et CONTROLES. Pour obtenir des comparaisons quantitatives, des méta-analyses furent réalisées pour chaque critère individuel. Les intervalles de confiance (CI) à 95% de chaque variation par rapport à l'inclusion, ont permis d'évaluer la pertinence clinique en se référant à un minimum validé dans la littérature de l'OA. L'investigation a été complétée par des comparaisons entre groupes et par l'évaluation de la tolérance. Résultats Pour les scores WOMAC A, B et C, l'intégralité de CI 95% était toujours supérieure à l'amélioration minimale cliniquement perceptible (MPCI), pour les groupes ARTHRUM et EQUIVALENTS, ce qui n'a pas été observé pour la totalité des critères, avec le groupe CONTROLES. Dans les comparaisons, les groupes ARTHRUM et EQUIVALENTS ont été significativement meilleurs que le groupe CONTROLES pour chaque critère. La taille de l'effet (ES) sur la douleur, pour les groupes ARTHRUM et EQUIVALENTS, a varié de 0,28 à 0,56 et de 0,23 to 0,27, respectivement. Globalement, ARTHRUM a toujours été évalué non-inférieur aux EQUIVALENTS, et parfois statistiquement et cliniquement supérieur. Conclusions La comparaison des études cliniques ARTHRUM, avec les études tirées de la recherche bibliographique, permet de conclure que l'efficacité clinique des dispositifs médicaux ARTHRUM, pour réduire la douleur et améliorer la fonction dans la gonarthrose, sur une période de six mois, est au moins aussi élevée que celle des dispositifs équivalents. Avec un bon profil de tolérance (taux plus faible d'effets indésirables, et aucun sévère), le rapport risque-bénéfice est en faveur de la viscosupplémentation avec ARTHRUM.
Collapse
Affiliation(s)
- Patrice Vincent
- Directeur R&D, LCA Pharmaceutical, 9 allée Prométhée, 28000 Chartres, France
| |
Collapse
|
4
|
Vincent P. Intra-articular hyaluronic acid in knee osteoarthritis: clinical data for a product family (ARTHRUM), with comparative meta-analyses. Curr Ther Res Clin Exp 2021; 95:100637. [PMID: 34712370 PMCID: PMC8529397 DOI: 10.1016/j.curtheres.2021.100637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/29/2021] [Indexed: 01/02/2023] Open
Abstract
Introduction Viscosupplementation is widely practiced, to reduce pain in osteoarthritis (OA), using intra articular (IA) injections of hyaluronic acid (HA). In Europe, these products are class III medical devices, for which the Medical Device Regulation (MDR) requires clinical assessment, based on specific studies and/or a bibliographical review of equivalent devices. The purpose of this article is to present a comparative review between a family of devices (ARTHRUM, from LCA Pharmaceuticals, Chartres, France) and an extensive group of presumed equivalent IA HA devices or their controls, whose results have been published in Scientific journals. Methods To meet the criteria used in most ARTHRUM studies, the Western Ontario and McMaster Universities’ index sub-scores were selected for pain (WOMAC A), stiffness (WOMAC B) and function (WOMAC C). The main criterion was the variation of the WOMAC A score from T0 (date of inclusion) to T6 (6 months). The other WOMAC criteria were assessed at T1, T3, T6 and complemented by OMERACT-OARSI rates of responders to the treatment. Fifty articles were selected, containing treatment details on more than 12,000 patients. These were divided into three groups: ARTHRUM, EQUIVALENTS and CONTROLS. To get quantitative comparisons, meta-analyses were performed for each criterion individually. The 95% confidence interval of each difference from baseline, was used to assess the clinical relevance, with reference to a minimum validated in OA literature. Comparisons between groups and tolerance assessment completed the investigation. Results For the WOMAC A, B and C scores, the full 95% CI was always above the minimal perceptible clinical improvement (MPCI), in the ARTHRUM and EQUIVALENTS groups, but not for all criteria in the CONTROLS group. In the comparisons, both ARTHRUM and EQUIVALENTS groups were significantly better than the CONTROLS group for each criterion. The effect size (ES) on pain, for the ARTHRUM and EQUIVALENTS groups, varied from 0.28 to 0.56 and from 0.23 to 0.27, respectively. Overall, ARTHRUM was estimated always non-inferior to EQUIVALENTS, and sometimes statistically and clinically superior. Conclusions The comparison of ARTHRUM clinical studies, with studies selected through bibliographic research, leads to the conclusion that the clinical efficacy of the ARTHRUM medical devices, to reduce pain and improve the function in knee OA, during a six-month period, is at least as great as those of equivalent products. With good tolerance results (lowest rate of adverse events, and none of them serious), the risk benefit ratio favours using viscosupplementation with ARTHRUM.
Collapse
Key Words
- AE, adverse event
- CD, Cohen's D (effect size)
- CI, confidence interval (with probability %)
- CS, chondroitin sulfate
- ES, effect size
- GAG, glycosaminoglycan
- HA, hyaluronic acid (sodium hyaluronate)
- IA, intra-articular
- KL, Kellgren-Lawrence (radiological OA severity scale)
- MD, mean difference
- MDR, Medical Device Regulation
- MPCI, minimal perceptible clinical improvement
- MSC, mesenchymal cells
- Mw, molecular weight (average in weight)
- NSAID, non-steroidal anti-inflammatory drug
- OA, osteoarthritis
- OARSI, Osteoarthritis Research Society International
- OMERACT, Outcomes Measurements in Rheumatology (international network)
- PRP, platelet rich plasma
- SAE, serious adverse event
- SD, standard deviation
- SE, standard error
- SF, synovial fluid
- SSD, smallest detectable difference
- WOMAC, Western Ontario & Mac Master Universities (OA index)
Collapse
Affiliation(s)
- Patrice Vincent
- R&D manager, LCA Pharmaceutical, 9 allée Prométhée, 28000 Chartres, France
| |
Collapse
|
5
|
Li P, Li H, Shu X, Wu M, Liu J, Hao T, Cui H, Zheng L. Intra-articular delivery of flurbiprofen sustained release thermogel: improved therapeutic outcome of collagenase II-induced rat knee osteoarthritis. Drug Deliv 2021; 27:1034-1043. [PMID: 32627602 PMCID: PMC8216450 DOI: 10.1080/10717544.2020.1787555] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Knee osteoarthritis (OA) is a common degenerative disease. Intra-articular administration of flurbiprofen is frequently employed in clinic to treat OA, while repeated injections are required because of the limited effective duration. To improve therapeutic outcome and prolong the treatment interval, a poly(ε-caprolactone-co-lactide)-b-poly(ethylene glycol)-b-poly(ε-caprolactone-co-lactide) (PCLA-PEG-PCLA) triblock copolymer based flurbiprofen thermosensitive gel for the sustained intra-articular drug delivery was designed in this study. The anti-OA effects of this flurbiprofen thermogel were investigated on collagenase II-induced rat knee OA model by multiple approaches and compared with that of conventional sodium hyaluronate and flurbiprofen injecta. In vitro drug release studies indicated that flurbiprofen was sustained released from the thermosensitive gel for more than three weeks. This sustained drug release system exerted comparable short-term analgesic effects and distinctly improved long-term analgesic efficacy in terms of the increased percentage of the total ipsilateral paw print intensity and the reduced Knee-Bend scores of OA rats. The inflammatory response was attenuated in the samples of flurbiprofen gel treated group by showing decreased IL-1, IL-6, and IL-11 levels in the joint fluid and down-regulated IL-1, IL-6, IL-11, COX-2, TNF-α, and NF-κB/p65 expression in the articular cartilages. The results suggest the suitability of thermosensitive copolymer PCLA-PEG-PCLA for sustained intra-articular effects of flurbiprofen and provide in vivo experimental evidence for potential clinical application of this flurbiprofen delivery system to better management of OA cases.
Collapse
Affiliation(s)
- Peinan Li
- Department of Orthopedic Surgery, Second Clinical College, Dalian Medical University, Dalian, China
| | - Haokun Li
- Department of Orthopedic Surgery, Second Clinical College, Dalian Medical University, Dalian, China
| | - Xiaohong Shu
- College of Pharmacy, Dalian Medical University, Dalian, China
| | - Moli Wu
- Department of Cell Biology, College of Basic Medical Sciences, Dalian Medical University, Dalian, China
| | - Jia Liu
- Department of Cell Biology, College of Basic Medical Sciences, Dalian Medical University, Dalian, China
| | - Tangna Hao
- Department of Pharmacy, Second Clinical College, Dalian Medical University, Dalian, China
| | - Hongxia Cui
- College of Pharmacy, Dalian Medical University, Dalian, China
| | - Lianjie Zheng
- Department of Orthopedic Surgery, Second Clinical College, Dalian Medical University, Dalian, China
| |
Collapse
|
6
|
Gueugnon M, Fournel I, Soilly AL, Diaz A, Baulot E, Bussière C, Casillas JM, Cherasse A, Conrozier T, Loeuille D, Maillefert JF, Mazalovic K, Timsit M, Wendling D, Ramon A, Binquet C, Morisset C, Ornetti P. Effectiveness, safety, and cost-utility of a knee brace in medial knee osteoarthritis: the ERGONOMIE randomized controlled trial. Osteoarthritis Cartilage 2021; 29:491-501. [PMID: 33524515 DOI: 10.1016/j.joca.2020.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 09/15/2020] [Accepted: 11/30/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This pragmatic, multicenter, open-label, randomized controlled trial (RCT) aimed to compare the effectiveness, safety, and cost-utility of a custom-made knee brace versus usual care over 1 year in medial knee osteoarthritis (OA). DESIGN 120 patients with medial knee OA (VAS pain at rest >40/100), classified as Kellgren-Lawrence grade II-IV, were randomized into two groups: ODRA plus usual care (ODRA group) and usual care alone (UCA group). The primary effectiveness outcome was the change in VAS pain between M0 and M12. Secondary outcomes included changes over 1 year in KOOS (function) and OAKHQOL (quality of life) scores. Drug consumption, compliance, safety of the knee brace, and cost-utility over 1 year were also assessed. RESULTS The ODRA group was associated with a higher improvement in: VAS pain (adjusted mean difference of -11.8; 95% CI: -21.1 to -2.5); all KOOS subscales (pain: +8.8; 95% CI: 1.4-16.2); other symptoms (+10.4; 95% CI: 2.7-18); function in activities of daily living (+9.2; 95% CI: 1.1-17.2); function in sports and leisure (+12.3; 95% CI: 4.3-20.3); quality of life (+9.9; 95% CI: 0.9-15.9), OAKHQOL subscales (pain: +14.8; 95% CI: 5.0-24.6); and physical activities (+8.2; 95% CI: 0.6-15.8), and with a significant decrease in analgesics consumption at M12 compared with the UCA group. Despite localized side-effects, observance was good at M12 (median: 5.3 h/day). The ODRA group had a more than 85% chance of being cost-effective for a willingness-to-pay threshold of €45 000 per QALY. CONCLUSIONS The ERGONOMIE RCT demonstrated significant clinical benefits of an unloader custom-made knee brace in terms of improvements in pain, function, and some aspects of quality of life over 1 year in medial knee OA, as well as its potential cost-utility from a societal perspective.
Collapse
Affiliation(s)
- M Gueugnon
- INSERM, CIC 1432, Centre D'Investigation Clinique, Module Plurithématique, Plateforme D'Investigation Technologiques, Dijon, France CHU Dijon-Bourgogne, Dijon, France.
| | - I Fournel
- INSERM, CIC 1432, Centre D'Investigation Clinique, Module EC, CHU Dijon-Bourgogne, Dijon, France.
| | - A-L Soilly
- Department of Clinical Research, Clinical Research Unit-Methodological Support Network CHU Dijon-Bourgogne, F-21000, Dijon, France.
| | - A Diaz
- Department of Rheumatology, CHU Dijon Bourgogne, F-21000 Dijon, France.
| | - E Baulot
- Department of Orthopedic Surgery, CHU Dijon Bourgogne, F-21000 Dijon, France; INSERM UMR 1093-CAPS, Bourgogne Franche-Comté University, UFR des Sciences et Du Sport.
| | - C Bussière
- Department of Orthopedic Surgery, Centre Orthopédique Medico-chirugical, Dracy-Le-Fort, France.
| | - J M Casillas
- INSERM, CIC 1432, Centre D'Investigation Clinique, Module Plurithématique, Plateforme D'Investigation Technologiques, Dijon, France CHU Dijon-Bourgogne, Dijon, France; INSERM UMR 1093-CAPS, Bourgogne Franche-Comté University, UFR des Sciences et Du Sport; Department of Physical Medicine and Rehabilitation, CHU Dijon Bourgogne, F-2100 Dijon, France.
| | - A Cherasse
- Department of Rheumatology, Hospital Center Mâcon, Mâcon, France.
| | - T Conrozier
- Department of Rheumatology, Hospital Nord Franche-Comté, Belfort, France.
| | - D Loeuille
- Department of Rheumatology, CHU Nancy, F-54500 Vandoeuvre-lès-Nancy, France INSERM, CIC-EC CIE6, Nancy, France University Hospital of Nancy, Epidemiology and Clinical Evaluation, F-54500 Vandoeuvre-lès-Nancy, France.
| | - J-F Maillefert
- Department of Rheumatology, CHU Dijon Bourgogne, F-21000 Dijon, France; INSERM UMR 1093-CAPS, Bourgogne Franche-Comté University, UFR des Sciences et Du Sport.
| | - K Mazalovic
- INSERM, CIC 1432, Centre D'Investigation Clinique, Module EC, CHU Dijon-Bourgogne, Dijon, France; Department of General Medicine, Bourgogne Franche-Comté University, UFR des Sciences de Santé, Dijon, France.
| | - M Timsit
- Department of Physical Medicine and Rehabilitation, Clinique de Provence Bourbonne, F-13400 Aubagne, France.
| | - D Wendling
- Department of Rheumatology, CHU Besançon EA4266 Bourgogne Franche-Comté University, F-25030 Besançon, France.
| | - A Ramon
- Department of Rheumatology, CHU Dijon Bourgogne, F-21000 Dijon, France.
| | - C Binquet
- INSERM, CIC 1432, Centre D'Investigation Clinique, Module EC, CHU Dijon-Bourgogne, Dijon, France.
| | - C Morisset
- INSERM, CIC 1432, Centre D'Investigation Clinique, Module Plurithématique, Plateforme D'Investigation Technologiques, Dijon, France CHU Dijon-Bourgogne, Dijon, France.
| | - P Ornetti
- INSERM, CIC 1432, Centre D'Investigation Clinique, Module Plurithématique, Plateforme D'Investigation Technologiques, Dijon, France CHU Dijon-Bourgogne, Dijon, France; Department of Rheumatology, CHU Dijon Bourgogne, F-21000 Dijon, France; INSERM UMR 1093-CAPS, Bourgogne Franche-Comté University, UFR des Sciences et Du Sport.
| |
Collapse
|
7
|
Primeau CA, Zomar BO, Somerville LE, Joshi I, Giffin JR, Marsh JD. Health Economic Evaluations of Hip and Knee Interventions in Orthopaedic Sports Medicine: A Systematic Review and Quality Assessment. Orthop J Sports Med 2021; 9:2325967120987241. [PMID: 34262974 PMCID: PMC8243245 DOI: 10.1177/2325967120987241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 11/24/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The economic burden of musculoskeletal diseases is substantial and growing. Economic evaluations compare costs and health benefits of interventions simultaneously to help inform value-based care; thus, it is crucial to ensure that studies are using appropriate methodology to provide valid evidence on the cost-effectiveness of interventions. This is particularly the case in orthopaedic sports medicine, where several interventions of varying costs are available to treat common hip and knee conditions. PURPOSE To summarize and evaluate the quality of economic evaluations in orthopaedic sports medicine for knee and hip interventions and identify areas for quality improvement. STUDY DESIGN Systematic review; Level of evidence, 3. METHODS The Medline, AMED, OVID Health Star, and EMBASE databases were searched from inception to March 1, 2020, to identify economic evaluations that compared ≥2 interventions for hip and/or knee conditions in orthopaedic sports medicine. We assessed the quality of full economic evaluations using the Quality of Health Economic Studies (QHES) tool, which consists of 16 questions for a total score of 100. We classified studies into quartiles based on QHES score (extremely poor quality to high quality) and we evaluated the frequency of studies that addressed each of the 16 QHES questions. RESULTS A total of 93 studies were included in the systematic review. There were 41 (44%) cost analyses, of which 21 (51%) inappropriately concluded interventions were cost-effective. Only 52 (56%) of the included studies were full economic evaluations, although 40 of these (77%) fell in the high-quality quartile. The mean QHES score was 83.2 ± 19. Authors consistently addressed 12 of the QHES questions; questions that were missed or unclear were related to statistical uncertainty, appropriateness of costing methodology, and discussion of potential biases. The most frequently missed question was whether the cost perspective of the analysis was stated and justified. CONCLUSION The number of studies in orthopaedic sports medicine is small, despite their overall good quality. Yet, there are still many highly cited studies based on low-quality or partial economic evaluations that are being used to influence clinical decision-making. Investigators should follow international health economic guidelines for study design and critical appraisal of studies to further improve quality.
Collapse
Affiliation(s)
- Codie A. Primeau
- School of Physical Therapy, Western University, London, Ontario, Canada
- School of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
- Bone and Joint Institute, Western University, London, Ontario, Canada
| | - Bryn O. Zomar
- School of Physical Therapy, Western University, London, Ontario, Canada
- School of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
- Bone and Joint Institute, Western University, London, Ontario, Canada
| | | | - Ishita Joshi
- School of Physical Therapy, Western University, London, Ontario, Canada
- School of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
- Bone and Joint Institute, Western University, London, Ontario, Canada
| | - J. Robert Giffin
- Bone and Joint Institute, Western University, London, Ontario, Canada
- London Health Sciences
Centre, University Hospital, London, Ontario, Canada
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jacquelyn D. Marsh
- School of Physical Therapy, Western University, London, Ontario, Canada
- School of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
- Bone and Joint Institute, Western University, London, Ontario, Canada
- London Health Sciences
Centre, University Hospital, London, Ontario, Canada
| |
Collapse
|
8
|
Vincent P. Acide hyaluronique intra articulaire dans la gonarthrose: une étude long-terme, ouverte, de Phase IV, avec analyse détaillée par stade de Kellgren-Lawrence. Curr Ther Res Clin Exp 2020; 92:100588. [PMID: 32714470 PMCID: PMC7379399 DOI: 10.1016/j.curtheres.2020.100588] [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: 05/13/2020] [Accepted: 05/13/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction Les injections intra articulaires (IA) d'acide hyaluronique (HA) désignées sous le nom de viscosupplémentation (VS), sont fréquemment utilisées dans le traitement symptomatique de la gonarthrose (OA), une affection ostéo-articulaire chronique douloureuse et handicapante, qui touche une fraction importante de la population âgée. La sévérité de la gonarthrose est en général décrite par la classification en stades radiologiques de Kellgren-Lawrence (KL). La VS a été largement étudiée à travers de nombreux essais cliniques; cependant, les résultats sont rarement analysés en détail, en fonction du stade KL. Méthode Une étude ouverte importante, portant sur 1 177 patients souffrant de gonarthrose, fut réalisée de 2004 à 2007. Chaque patient a reçu un traitement de VS consistant en 3 injections d'ARTHRUM H 2% (LCA Pharmaceutical, Chartres, France). A l'inclusion, les patients ont été décrits par leur profil démographique, leur indice de masse corporelle (IMC), leur stade KL et leur état clinique selon les sous-scores douleur et fonction de l'indice Western Ontario and McMaster Universities (WOMAC). Les visites de suivi étaient à M3, M6 et M9 (mois) après la VS. Cette large base de données a été entièrement retraitée en 2019, de manière à fournir une analyse séparée par stade KL, et fut complétée par l'évaluation des taux de patients répondeurs (%) au traitement, selon l'Outcome Measures in Rheumatoid Arthritis Clinical Trials & Osteoarthritis Research Society International (OMERACT-OARSI). L'analyse fut menée à la fois sur les populations en intention de traiter (ITT) et per protocole (PP) ayant terminé l'étude. Résultats En analyse ITT du critère principal, les variations du sous-score WOMAC A (douleur) depuis l'inclusion jusqu'à la fin de l'étude, ont été respectivement de 19,8 ; 19,8 ; 17,8 et 14,2, sur une échelle de 0-100, pour les patients des stades KL I à KL IV. En analyse PP dans les mêmes conditions, ces variations ont été de 20,6 ; 19,9 ; 17,1 et 11,7. Tous ces résultats étaient significatifs par rapport aux valeurs à l'inclusion (p<0.001) et cliniquement pertinents à chaque stade KL. Des améliorations significatives ont été également observées pour le sous-score WOMAC C (fonction), et pour les autres critères secondaires. Le taux de répondeurs OMERACT-OARSI variait de 72 à 82% pour les patients KL I à III à M6 et M9. Pour les patients KL IV, le maximum atteint a été 47.7% à M6. Les autres paramètres tels que le sexe, l'IMC ou l'âge, ne furent pas identifiés comme des facteurs de pronostic pour la réponse à la VS. Conclusions L'analyse détaillée par stade KL d'une large cohorte de patients suivis en ouvert, suggère le traitement de VS avec ARTHRUM H 2% est applicable à une grande variété de patients gonarthrosiques.
Collapse
Key Words
- AINS, Anti-Inflammatoire Non Stéroidïen
- ANAES, Agence nationale d'accréditation et d’évaluation en santé (remplacée par la HAS en 2005)
- CE mark, Approbation de la Communauté Européenne
- CNEDIMTS, Commission Nationale d'Evaluation des Dispositifs Médicaux et des Technologies de Santé
- CRF, Cahier d'observations (Case report form)
- CRO, Organisation de recherche Clinique (Clinical research organization)
- CRT, Essai contrôlé randomisé (Controlled randomized trial)
- ES, Taille d'effet (Effect size) = définie comme le d de Cohen
- HA, Acide hyaluronique (hyaluronate de sodium)
- HAS, Haute autorité de santé (French health authority)
- IA, Intra articulaire (injection)
- IC, Intervalle de confiance (en général IC 95%)
- IMC, indice de masse corporelle, en kg/m2 (IMC = poids/taille2)
- INSEE, Institut national de la statistique et des études économiques
- ITT, Intention de traiter (Intent To Treat)
- Intra articulaire
- KL, Kellgren-Lawrence (échelle radiologique de l'ostéo-arthrose: stades I à IV)
- M0 à M9, Temps de suivi, en mois (M0 = baseline)
- MD, Différence moyenne (mean difference)
- MIX 2.0, Logiciel de méta-analyse (BiostatXL)
- NA, Non disponible (not available)
- OA, Ostéo-arthrose
- OARSI, Osteoarthritis research society international
- OMERACT, Outcome measures in rheumatoid arthritis clinical trials (international initiative)
- OR, odds ratio (ou rapport de cote)
- Ostéo-arthrose
- PP, Per protocol
- PTG, Prothèse totale du genou
- SD, Ecart-type (standard deviation)
- SE, Erreur standard (standard error)
- SMD, Différence moyenne standardisée (Standard mean difference): équivaut à la taille d'effet
- VS, Viscosupplémentation
- Viscosupplémentation
- WOMAC, Western Ontario & McMaster Universities (indice d’évaluation des symptômes de l'OA)
Collapse
Affiliation(s)
- Patrice Vincent
- Thibaut LUCAS DE COUVILLE, master de sciences biologiques (DEA).,Thierry THOMAS, docteur en médecine, professeur des hôpitaux
| |
Collapse
|
9
|
Vincent P, Lucas de Couville T, Thomas T. Intra-Articular Hyaluronic Acid for Knee Osteoarthritis: A Postmarket, Open-Label, Long-Term Historical Control Study with Analysis Detailed per Krellgren-Lawrence Radiologic Osteoarthritis Scale Grade. Curr Ther Res Clin Exp 2020; 92:100575. [PMID: 32211082 PMCID: PMC7082599 DOI: 10.1016/j.curtheres.2020.100575] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 01/03/2020] [Indexed: 01/22/2023] Open
Abstract
Background Intra-articular injections of hyaluronic acid—also called viscosupplementation (VS)—is frequently used for the symptomatic treatment of knee osteoarthritis, a painful and debilitating long-term disease, affecting an important fraction of elderly populations. Severity of knee osteoarthritis is generally described by Kellgren-Lawrence (KL) radiological classification. VS has been widely studied in many clinical trials; however, the results are rarely analyzed in detail according to KL grade. Method A large, clinical, open-label study was performed in 2004–2007 on 1177 patients with knee osteoarthritis, each treated with VS consisting of 3 injections of Arthrum H 2% (LCA Pharmaceutical, Chartres, France). The characteristics of the patients at baseline included demographic profile, body mass index, KL grade, and clinical scores for pain and function using the Western Ontario and McMaster Universities index. Follow-up visits were at 3, 6, and 9 months after VS procedure. This large database was entirely reprocessed in 2019 to provide a separate analysis per KL grade, complemented by the assessment of the Outcome Measures in Rheumatoid Arthritis Clinical Trials-Osteoarthritis Research Society International rates (%) of responders to the treatment. The analysis was carried out for both intention-to-treat and per-protocol completer populations. Results A primary outcome in the intention-to-treat analysis, variations of the Western Ontario and McMaster Universities index pain subscore from inclusion to the end of the study were 19.8, 19.8, 17.8, and 14.2 for KL grade I to KL grade IV patients, respectively, on a 0 to 100 scale. In the per-protocol analysis, under the same conditions, the variations were 20.6, 19.9, 17.1, and 11.7. All results were significant (P < 0.001) and clinically relevant for each KL grade. Significant improvements were also observed for the Western Ontario and McMaster Universities index function subscore and for the other secondary outcomes. The Outcome Measures in Rheumatoid Arthritis Clinical Trials-Osteoarthritis Research Society International responders rate reached 72% to 82% for KL grade I through III patients at Month 6 and Month 9. For KL grade IV patients, the maximum rate reached was 47.7% at Month 6. There was evidence that KL grade is a critical parameter, particularly if KL grade IV is present. Other parameters such as gender, body mass index, and age were not identified as prognostic factors of response to VS based on χ2 and odds ratio (95% CI) testing. Conclusions Detailed analysis by KL grade supports that VS treatment with Arthrum H 2% applies to a large variety of patients with knee osteoarthritis.
Collapse
Affiliation(s)
| | | | - Thierry Thomas
- Department of Rheumatology, University Hospital Centre, St Etienne, France
| |
Collapse
|
10
|
Recombinant platelet-derived growth factor-BB and hyaluronic acid stimulates knee cartilage regeneration by forming higher chondrocytes count and lower YKL-40 level in rats model. J Clin Orthop Trauma 2020; 11:S76-S79. [PMID: 31992922 PMCID: PMC6978183 DOI: 10.1016/j.jcot.2019.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/29/2018] [Accepted: 01/14/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Osteoarthritis is caused by cartilage degeneration arising from cartilage degradation of type II collagen which synthesis also deteriorated. Nowadays, osteoarthritis is still difficult to handle because of the irreversibility and progressivity of the disease. Regenerative therapy offers a great challenge and better result for osteoarthritis treatment. This study aims to prove that the administration of recombinant platelet-derived growth factor-BB (rrPDGF-BB) with hyaluronic acid (HA) can stimulate the higher forms of chondrocyte and lower the YKL-40 levels as a specific marker of cartilage degradation in mouse knee osteoarthritis model. METHOD This was an experimental study, post-test only control group design using white Wistar rats as subjects that were induced by monosodium iodoacetate (MIA) to create osteoarthritis (OA). The treatment group was given treatment group was given rrPDGF-BB and HA, while no such treatment was given to the control group. The chondrocyte cell count was examined with routine histopathology, and YKL-40 levels were calculated by ELISA. RESULT Statistical analysis using independent t-test showed that the mean difference in the number of cell counts of chondrocytes was significantly higher than the control group. While the mean difference of YKL-40 level in the treatment group was significantly lower compared to the control group with. CONCLUSION We conclude that the administration of rrPDGF-BB and HA in mouse knee joint osteoarthritis model have a regenerative effect on knee joint cartilage characterized by a higher number of chondrocytes and lower YKL-40 levels.
Collapse
|
11
|
Conrozier T, Eymard F, Chouk M, Chevalier X. Impact of obesity, structural severity and their combination on the efficacy of viscosupplementation in patients with knee osteoarthritis. BMC Musculoskelet Disord 2019; 20:376. [PMID: 31421686 PMCID: PMC6698328 DOI: 10.1186/s12891-019-2748-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 07/31/2019] [Indexed: 01/15/2023] Open
Abstract
Background Obesity and radiological severity have been identified to be independent predictors of a low rate of response to viscosupplementation (VS), in patients with knee osteoarthritis (OA). Is that enough to formally refute VS in such patients in whom surgery is sometimes contraindicated? Objectives To compare pain and function scores before and 6 months after knee VS, according to the weight status (obese versus non obese), the radiological severity (mild/moderate versus severe) and both combined. Methods Post-hoc analysis of a prospective, double blind, randomized, multicentre trial, comparing 2 viscosupplements, in patients with symptomatic knee OA. Patients were classified according to body mass index (BMI < or ≥ 30 kg.− 2), OARSI radiological grade (1–2 versus 3) and OMERACT-OARSI response criteria (Yes/No). WOMAC between-group comparisons (obese versus non-obese, OARSI 1–2 versus 3, and both combined) in all patients and in OMERACT-OARSI Responders, were achieved using Mannn-Whitney U test. Results One-hundred and sixty-six patients were analyzed: 28.3% were obese, 44% were OARSI grade 3, 42,2% were neither obese nor OARSI 3, whereas 14.5% were obese and OARSI 3. At baseline WOMAC pain score did not differ according to the patients sub-groups (p > 0.05). Six months after VS, WOMAC pain decreased significantly in all patient sub-groups (all p < 0.01). At month 6, WOMAC pain sub-score was significantly lower in non-obese than in obese patients (4.9 ± 4.1 versus 7.1 ± 4.9; p = 0.008) and in patients OARSI 1–2 versus 3 (4.8 ± 4.3 versus 6.4 ± 4.5; p = 0.009). However, in responder patients there was no difference in pain score and pain decrease related to the weight status and the radiological score. Conclusion These results do not confirm our previous conclusions that recommended not performing VS in obese patients with severe knee OA. Although the chances of being a responder were much reduced in these patients, the benefit of patients who respond to treatment was similar to that of subjects with normal weight and mild/moderate OA. Different pain phenotypes, more than overweight and advanced disease, might be the main reason for the success or failure of VS.
Collapse
Affiliation(s)
- Thierry Conrozier
- Department of rheumatology, Hôpital Nord Franche-Comté, 100 route de Moval, CS 10490, Trevenans, 90015, Belfort, France.
| | - Florent Eymard
- Department of Rheumatology, Hôpital Henri Mondor, Creteil, France
| | - Mickael Chouk
- Department of rheumatology, Hôpital Nord Franche-Comté, 100 route de Moval, CS 10490, Trevenans, 90015, Belfort, France
| | - Xavier Chevalier
- Department of Rheumatology, Hôpital Henri Mondor, Creteil, France
| |
Collapse
|
12
|
Migliore A, Integlia D, Pompilio G, Di Giuseppe F, Aru C, Brown T. Cost-effectiveness and budget impact analysis of viscosupplementation with hylan G-F 20 for knee and hip osteoarthritis. CLINICOECONOMICS AND OUTCOMES RESEARCH 2019; 11:453-464. [PMID: 31413608 PMCID: PMC6659788 DOI: 10.2147/ceor.s194669] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 06/06/2019] [Indexed: 12/16/2022] Open
Abstract
Purpose To estimate the cost-effectiveness and budget impact of viscosupplementation with one intra-articular (IA) injection of 6 mL hylan G-F 20 (Synvisc-One®) and with three injections of 2 mL hylan G-F 20 (Synvisc®3×2) in knee osteoarthritis (OA) patients compared with conventional support therapy (CST - eg, NSAIDs and acetaminophen) and the cost-effectiveness of one IA injection of 2 mL hylan G-F 20 (Synvisc®1×2) in hip OA patients compared with CST from an Italian Health System perspective. Methods The model used was a Markov model with states for stages II-IV on the Kellgren-Lawrence scale and runs on 6-month cycles over a 5-year time horizon. A 3.5% discount was applied to both costs and utilities. Direct costs were determined from the perspective of the Italian National Health Service. A one-way and probabilistic sensitivity analysis was conducted for both comparisons. Results Hylan G-F 20 1×6 mL and hylan G-F 20 3×2 mL for knee OA were very likely to be cost-effective when compared to acetaminophen (ICER = €3,160.61 and €3,845.81 per QALY, respectively) and NSAIDs as both ICERs are below €25,000. The hip OA treatment by hylan G-F 20 1×2 mL was dominant compared to NSAIDs and very likely compared to acetaminophen. The results of the cost-effectiveness analysis were confirmed by one-way sensitivity analysis. The budget impact analysis for knee and hip OA showed a small increase in expenditure during 5 years. Conclusions Hylan G-F 20 1×6 mL/hylan G-F 20 is a cost-effectiveness treatment compared to NSAIDs and acetaminophen in the treatment of knee/hip OA in Italy. The treatment of hip and knee OA resulted in cost-saving with hylan G-F 20 1×2 mL and economically sustainable with hylan G-F 20 1×6 mL. However, Real Word Evidence studies should be conducted in order to estimate costs associated with both prosthetics and to understand the reduction of physiotherapy and medication due to hylan G-F 20.
Collapse
Affiliation(s)
- Alberto Migliore
- Unit of Rheumatology, San Pietro Fatebenefratelli Hospital, Rome, Italy
| | | | | | | | | | - Tray Brown
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| |
Collapse
|
13
|
de Campos GC, de Sousa EB, Hamdan PC, de Almeida CS, Tieppo AM, de Rezende MU, Alchaar AADA, Pinheiro CB, Rocha EDMC, Cunha FG, Pacheco I, Vieira MSR, Antonio SF, Menegassi ZJB. BRAZILIAN CONSENSUS STATEMENT ON VISCOSUPPLEMENTATION OF THE KNEE (COBRAVI). ACTA ORTOPEDICA BRASILEIRA 2019; 27:230-236. [PMID: 31452625 PMCID: PMC6699386 DOI: 10.1590/1413-785220192704218616] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 03/13/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The aim of this consensus statement on viscosupplementation is to serve as a reference document based on relevant literature and clinical experience in the treatment of knee osteoarthritis using an intra-articular injection of hyaluronic acid, covering key aspects such as clinical indications, effectiveness, and tolerability. METHODS A multidisciplinary panel including two sports medicine physicians, six orthopedists, four physiatrists, and two rheumatologists were selected based on their clinical and academic experience of viscosupplementation. Sixteen statements were prepared and discussed, after which a vote was held. Each member of the panel gave a score between 0 and 10 on a Likert scale, specifying their level of agreement with the statement. RESULTS The panel reached a consensus on several issues. Specifically, the panel agreed that the best indication is for mild to moderate knee arthrosis; prior or concomitant use of intraarticular triamcinolone hexacetonide may optimize the effect of hyaluronic acid; viscosupplementation should not be performed as an isolated procedure but in conjunction with other rehabilitative and pharmacological measures; viscosupplementation has analgesic, anti-inflammatory, and chondroprotective effects; and viscosupplementation is cost-effective. CONCLUSION This consensus statement provides clear information and guidance for both individuals and payers. Level of evidence V, Consensus statement.
Collapse
Affiliation(s)
| | | | - Paulo César Hamdan
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | | | | | - Marcia Uchôa de Rezende
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Department of Orthopedics and Traumatology (DOT/FMUSP), São Paulo, Brazil
| | | | | | | | | | - Ivan Pacheco
- Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | | | | | | |
Collapse
|
14
|
Comparison of the effect of topical use of Nigella Sativa oil and diclofenac gel on osteoarthritis pain in older people: A randomized, double-blind, clinical trial. J Herb Med 2019. [DOI: 10.1016/j.hermed.2019.100259] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
15
|
Baron D, Flin C, Porterie J, Despaux J, Vincent P. Inyección Intraarticular Única de Ácido Hialurónico en la Artrosis de Rodilla: Estudio Multicéntrico Prospectivo Abierto (ART-ONE 75) mediante Comparación Post-Hoc con Placebo. Curr Ther Res Clin Exp 2019; 90:69-83. [PMID: 31193495 PMCID: PMC6531630 DOI: 10.1016/j.curtheres.2019.04.002] [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: 04/25/2019] [Accepted: 04/25/2019] [Indexed: 11/02/2022] Open
Abstract
Introducción La viscosuplementación del líquido sinovial mediante la inyección intraarticular (IA) de ácido hialurónico (AH) es un tratamiento sintomático ampliamente utilizado en la artrosis de rodilla (AR). Además de los productos diseñados para realizar inyecciones múltiples (normalmente de 3 a 5 inyecciones, en intervalos de 1 semana), se presta especial atención a los productos de una única inyección, ya que ofrecen ventajas específicas, como son un menor número de visitas al médico y de intervenciones invasivas con sus riesgos asociados. Sin embargo, aún existen dudas sobre la eficacia de estas inyecciones únicas, en comparación con los regímenes de inyecciones múltiples. Métodos Se realizó un estudio multicéntrico, abierto, prospectivo, post-mercado (ART-ONE 75) con el producto de inyección única ARTHRUM 2,5% (3 ml, 75 mg AH), en 214 pacientes que sufrían de AR. Los pacientes fueron seguidos en D30, D60, D120 y D180 (días). El perfil promedio de los pacientes en el momento de la inclusión fue de 62,9 años, 56% mujeres, grados I-III de Kellgren-Lawrence (46% KL III), IMC de 27,2 kg/m2 y 4 años desde el diagnóstico de AR. Se realizó una comparación post-hoc con una inyección IA única de placebo (326 pacientes, agrupados de 3 estudios ECA), que proporcionaron un perfil de paciente similar. Resultados el criterio principal fue la variación desde el inicio de la puntuación de la escala WOMAC A (dolor, escala 0-100) en D60, que se redujo en 28,9 (17,4) para la población por intención de tratar (ITT, por sus siglas en inglés) (199 pacientes), 28,0 (17,8) para la población por protocolo (PP) en la inclusión (175 pacientes), y en 27,7 (16,8) para la población PP al finalizar (143 pacientes).Los criterios secundarios y accesorios incluyeron WOMAC A en otras ocasiones, WOMAC B (rigidez), WOMAC C (función), calidad de vida y discapacidad en cada momento de seguimiento. Todos los índices mejoraron significativamente y continuaron mejorando al final del estudio. La evaluación terapéutica en D180 mostró que más del 75% de los pacientes se encontraban satisfechos con la reducción del dolor, la mejora de la movilidad, y la reducción de analgésicos y AINE. El porcentaje de pacientes definidos como respondedores de OMERACT-OARSI fue superior al 86%, a partir de D60 y en adelante. La tolerancia general fue buena, sin que ocurriera ningún evento adverso grave. El resultado de la comparación post-hoc para la escala WOMAC A mostró un tamaño del efecto [IC 95%] desde TE = 0,33 [0,15; 0,51] en D60 a TE = 0,65 [0,45; 0,85] en D180 (p <0,001), frente a la inyección de placebo (solución salina), lo cual es un resultado clínicamente relevante a favor de ARTHRUM 2,5%. Conclusión El presente estudio confirma la eficacia clínica de una única inyección IA de 3 ml de solución de AH conteniendo 75 mg de AH nativo de alto PM (> 2 MDa).
Collapse
Key Words
- AH, Ácido hialurónico (o hialuronato de sodio)
- AINE, Antiinflamatorio no esteroideo
- ANAES, Agence nationale d'accréditation et d’évaluation en santé (``reemplazado por HAS desde 2005'')
- AR, Artrosis de rodilla
- CCTIRS, Comité consultatif sur le traitement de l'information en matière de recherche dans le domaine de la santé
- CD 44, Receptor específico para el ácido hialurónico, en la periferia de las células.
- CE, Conformidad Europea
- CNIL, Commission nationale de l'informatique et des libertés
- CV, Calidad de vida
- DE, Desviación estándar
- DME, Diferencia de medias estandarizada
- ECA, Ensayo controlado aleatorizado
- ESCEO, European society for clinical and economic aspects of osteoporosis and osteoarthritis
- FRC, Formulario de reporte de caso
- HAS, Haute autorité de santé
- IA, Intraarticular
- IMC, Índice de masa corporal (= peso/altura2 en kg/m2)
- ITT, Intención de tratar
- KL, Kellgren-Lawrence (escala radiológica de AR, con grados de I a IV)
- MDa, Millón de Daltons (unidad de peso molecular = 106 Dalton)
- OARSI, Osteoarthritis research society international
- OIC, Organización de investigación clínica
- OMERACT, Outcome measures in rheumatoid arthritis clinical trials (iniciativa internacional)
- PP, Por protocolo
- TE, Tamaño del efecto TE (Cohen's d)
- WOMAC, Western Ontario & Mac Master Universities (Indice de artrosis de rodilla o cadera)
Collapse
Affiliation(s)
- Dominique Baron
- Rhumatologue, Centre Hospitalier de Lannion, Lannion, France
| | - Christian Flin
- Médecin de Médecine Physique et Réadaptation, St Raphaël, France
| | | | | | | |
Collapse
|
16
|
Maheu E, Bannuru RR, Herrero-Beaumont G, Allali F, Bard H, Migliore A. Why we should definitely include intra-articular hyaluronic acid as a therapeutic option in the management of knee osteoarthritis: Results of an extensive critical literature review. Semin Arthritis Rheum 2019; 48:563-572. [DOI: 10.1016/j.semarthrit.2018.06.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/24/2018] [Accepted: 06/11/2018] [Indexed: 12/16/2022]
|
17
|
Salmon JH, Rat AC, Charlot-Lambrecht I, Eschard JP, Jolly D, Fautrel B. Cost Effectiveness of Intra-Articular Hyaluronic Acid and Disease-Modifying Drugs in Knee Osteoarthritis. PHARMACOECONOMICS 2018; 36:1321-1331. [PMID: 30047014 DOI: 10.1007/s40273-018-0695-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND The place of disease-modifying osteoarthritis drugs (DMOADs) and intra-articular hyaluronic acid (IAHA) in the therapeutic arsenal for knee osteoarthritis (OA) remains uncertain. Indeed, these treatments have demonstrated symptomatic efficacy but no efficacy for disease modification. OBJECTIVE This report reviews the cost effectiveness of IAHA and DMOADs used in the treatment of knee OA. METHODS A systematic literature search of the MEDLINE, Scopus, EMBASE and Cochrane databases was performed independently by two rheumatologists who used the same predefined eligibility criteria to identify relevant articles. Papers without abstracts and in languages other than English or French were excluded. Extracted costs were annualised and converted to 2015 euros (€) using the Consumer Price Index of the relevant countries and the 2013 Purchasing Power Parities between these countries and the European Union average. RESULTS A total of 95 abstracts were selected, and 13 articles were considered for the review: nine articles on IAHA and four on DMOADs. Only one article directly compared different IAHA compounds. Articles showed substantial heterogeneity in methodological approaches. The incremental cost-effectiveness ratios (ICERs) ranged from €4000 to €57,550 and from €240 to €53,225 per quality-adjusted life-year (QALY) gained for DMOADs and IAHA, respectively. CONCLUSIONS This review highlights substantial heterogeneity between studies, ranging from a cost saving (or dominating) position to very high ICERs, far above the acceptability threshold of €50,000/QALY. Additional research is needed to determine reliable and robust ICER estimates for knee OA therapies.
Collapse
Affiliation(s)
- Jean-Hugues Salmon
- Rheumatology Department, Maison Blanche Hospital, Reims University Hospitals, Reims, 51092, France.
- Faculty of Medicine, EA 3797, University of Reims Champagne-Ardenne, Reims, 51095, France.
| | - Anne-Christine Rat
- Rheumatology Department, CHRU de Nancy, Hôpitaux de Brabois, Vandoeuvre-lès-Nancy, France
- Université de Lorraine, APEMAC, 54000, Nancy, France
- INSERM, CIC-EC 1433, 54000, Nancy, France
| | | | - Jean-Paul Eschard
- Rheumatology Department, Maison Blanche Hospital, Reims University Hospitals, Reims, 51092, France
| | - Damien Jolly
- Faculty of Medicine, EA 3797, University of Reims Champagne-Ardenne, Reims, 51095, France
- Department of Research and Innovation, Robert Debré Hospital, Reims University Hospitals, 51092, Reims, France
| | - Bruno Fautrel
- Sorbonne Université, Institut Pierre Louis de d'Epidémiologie et Santé Publique, GRC08, Paris, France
- Rheumatology Department, AP-HP, Pitié-Salpêtrière Hospital, 83 Boulevard de l'Hôpital, 75013, Paris, France
| |
Collapse
|
18
|
Baron D, Flin C, Porterie J, Despaux J, Vincent P. Mono-injection intra-articulaire d'acide hyaluronique dans la gonarthrose : Étude multicentrique prospective ouverte (ART-ONE 75) avec comparaison post hoc versus placebo. Curr Ther Res Clin Exp 2018; 89:7-19. [PMID: 30167002 PMCID: PMC6111040 DOI: 10.1016/j.curtheres.2018.07.002] [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: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction La viscosupplémentation du liquide synovial par injection intra-articulaire d'acide hyaluronique est un traitement symptomatique de l'arthrose, largement utilisé dans la gonarthrose (arthrose du genou). À côté des produits conçus pour être administrés par injections multiples (typiquement 3 à 5 injections à intervalles de 1 semaine), un intérêt particulier se porte sur produits en injection unique (mono-injection) qui offrent des avantages spécifiques tels que la réduction du nombre de visites au médecin et du nombre d'interventions invasives avec leurs risques associés. Il subsiste toutefois une question concernant l'efficacité de ces mono-injections, par rapport aux protocoles à injections multiples. Méthodes Une étude post-commercialisation, prospective, multicentrique, ouverte (ART-ONE 75), a été réalisée avec le produit pour injection unique Arthrum 2,5 % (3 mL, 75 mg d'acide hyaluronique) (LCA Pharmaceutical, Chartres, France), sur 214 patients atteints de gonarthrose. Les patients ont été suivis à 30, 60, 120 et 180 jours. Le profil moyen des patients à l'inclusion était un âge de 62,9 ans, 56 % de femmes, un stade radiologique Kellgren-Lawrence de I à III (46 % KL III), un indice de masse corporelle de 27,2 kg/m2 et une antériorité de 4 ans pour la gonarthrose. Une comparaison post hoc a été réalisée par rapport à une injection intra-articulaire unique de placebo (326 patients regroupés à partir de 3 essais randomisés contrôlés), et présentant un profil similaire de patients. Résultats Le critère principal était la variation par rapport à la baseline, de l'indice Western Ontario and McMaster Universities, sous-échelle de la douleur (WOMAC A) dont le score (base 0–100), était réduit à 60 jours, de 28,9 (17,4) pour la population en intention de traiter (199 patients), de 28,0 (17,8) pour la population per protocole à l'inclusion (175 patients), et de 27,7 (16.8) pour la population per protocole ayant terminé l'étude (143 patients). Les critères secondaires et accessoires comprenaient le score WOMAC A aux autres dates, le score WOMAC B (raideur), le score WOMAC C (fonction), la qualité de vie et le handicap à chaque date de suivi. Tous les indices étaient significativement améliorés et continuaient à s'améliorer à la fin de l’étude. L’évaluation thérapeutique à 180 jours a montré que plus de 75 % des patients étaient satisfaits de la réduction de la douleur, de l'amélioration de la mobilité et de la réduction de la consommation d'analgésiques et d'anti-inflammatoires non stéroïdiens. Le pourcentage de patients définis comme répondeurs selon les critères de l'OMERACT–OARSI Initiative était > 86 %, à partir de 60 jours. La tolérance globale était bonne, sans aucun évènement indésirable grave. Les résultats de la comparaison post hoc pour le score WOMAC A ont montré une taille d'effet variant de 0,33 (IC 95 % 0,15–0,51), à 60 jours à 0,65 (IC 95 % 0,45–0,85) à 180 jours (p < 0.001), versus placebo injecté (solution saline), qui est cliniquement significative en faveur d'Arthrum 2,5 %. Conclusion La présente étude suggère l'efficacité clinique d'une mono-injection IA de 3 mL de solution viscoélastique contenant 75 mg d'AH natif de haut poids moléculaire (> 2 MDa).
Collapse
Key Words
- AH, Acide hyaluronique
- AINS, Anti-inflammatoirers non stéroïdiens
- ANAES, Agence nationale d'accréditation et d’évaluation en santé (remplacée par la HAS depuis 2005)
- CCTIRS, Comité consultatif sur le traitement de l'information en matière de recherche dans le domaine de la santé
- CD 44, Récepteur spécifique de l'acide hyaluronique, situé à la périphérie des cellules
- CNIL, Commission nationale de l'informatique et des libertés
- CRF, Case report form (cahier d'observation)
- CRO, Clinical research organization (organisation de recherche clinique)
- ES, Effect size (Taille d'effet : d de Cohen)
- ESCEO, European society for clinical and economic aspects of osteoporosis and osteoarthritis
- HAS, Haute autorité de santé
- IA, Intra-articulaire
- IMC, Indice de masse corporelle (= poids / taille2 en kg/m2)
- ITT, Intention de traiter
- KL, Kellgren-Lawrence (échelle de l'arthrose, avec stades radiologiques de I à IV)
- MDa, Millions de Dalton (unité de poids moléculaire = 106 Dalton)
- OA, Osteoarthrite ou arthrose
- OARSI, Osteoarthritis research society international
- OMERACT, Outcome measures in rheumatoid arthritis clinical trials (international initiative)
- PP, Per protocole
- QoL, Quality of life (qualité de vie)
- RCT, Randomized controlled trial (essai randomisé contrôlé)
- SD, Écart type
- SMD, Différence moyenne standardisée
- WOMAC, Western Ontario & Mac Master Universities
Collapse
Affiliation(s)
- Dominique Baron
- Rhumatologue, Centre Hospitalier de Lannion, Lannion, France
| | - Christian Flin
- Médecin de Médecine Physique et Réadaptation, St Raphaël, France
| | | | | | | |
Collapse
|
19
|
Bert J, Kenney J, Sgaglione NA, McClelland S, Brophy R, Toth J, Ruane J, Ali Y, Arquette S, Dasa V, Lopes M. Viscosupplementation for Osteoarthritis of the Knee: A Key Opinion Leader Panel Discussion. J Manag Care Spec Pharm 2018; 24:S2-S8. [PMID: 29851537 PMCID: PMC10408395 DOI: 10.18553/jmcp.2018.24.6-a.s2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED With a sharp rise in the prevalence of osteoarthritis of the knee (OAK) in a younger population, new management strategies are needed to preserve mobility, improve patients' quality of life, and reduce the effects of potential disease-related comorbidities. Viscosupplementation with the use of hyaluronic acid (HA) injection is a treatment option for OAK that can provide lubrication and elastic shock absorption, leading to potential pain relief, improved function, and reduced stiffness. A key opinion leader (KOL) panel discussion was held December 3, 2016, with the objective of sharing opinions, ideas, information, and trends regarding OAK and the potential treatment and management offered by viscosupplementation. The panel concluded that viscosupplementation with HA injections presents a viable, cost-effective, and safe alternative for the treatment of OAK. DISCLOSURES This panel discussion and report was facilitated by Magellan Rx Manage-ment and funded by Sanofi. Bert and Ruane report fees from Sanofi outside of this project. Sgaglione reports royalty payments from Zimmer Biomet and Wolters Kluwer. Dasa has received fees from Bioventus and Myoscience. All the authors received an honorarium for work on this project. Lopes is employed by Magellan Rx Management.
Collapse
Affiliation(s)
- Jack Bert
- 1 University of Minnesota School of Medicine, Minneapolis
| | - Jim Kenney
- 2 Harvard Pilgrim Healthcare, Wellesley, Massachusetts
| | | | | | - Robert Brophy
- 5 Washington University School of Medicine, St. Louis, Missouri
| | - John Toth
- 6 Yale Health, New Haven, Connecticut
| | - Joseph Ruane
- 7 McConnell Spine, Sport, and Joint Center, Columbus, Ohio, and Ohio University College of Osteopathic Medicine, Athens
| | - Yousaf Ali
- 8 Icahn School of Medicine at Mt. Sinai, New York, New York
| | | | - Vinod Dasa
- 10 Louisiana State University Health Sciences Center, New Orleans; Oschner Kenner Medical Center, Kenner, Louisiana; Vector Medical, Boca Raton, Florida; and Touro University Nevada College of Osteopathic Medicine, Henderson, Nevada
| | | |
Collapse
|
20
|
Baron D, Flin C, Porterie J, Despaux J, Vincent P. Hyaluronic Acid Single Intra-Articular Injection in Knee Osteoarthritis: A Multicenter Open Prospective Study (ART-ONE 75) with Placebo Post Hoc Comparison. Curr Ther Res Clin Exp 2018; 88:35-46. [PMID: 30069277 PMCID: PMC6066596 DOI: 10.1016/j.curtheres.2018.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2018] [Indexed: 12/21/2022] Open
Abstract
Background Viscosupplementation of the synovial liquid, by intra-articular injection of hyaluronic acid, is a widely used symptomatic treatment in knee osteoarthritis. Besides products designed for multi-injections (typically 3–5 injections at 1-week intervals), special interest is being given to single-injection products that offer specific advantages such as the reduction of the number of visits to the doctor and the number of invasive interventions with their associated risks. However, a question remains about the efficacy of these monoinjections, compared with the multi-injections regimens. Methods A postmarket, prospective, multicenter, open study (ART-ONE 75), was performed with the single-injection product Arthrum 2.5% (3 mL, 75 mg hyaluronic acid) (LCA Pharmaceutical, Chartres, France), on 214 patients with knee osteoarthritis. Patients were followed at 30, 60, 120, and 180 days. The average patient profile at inclusion was age 62.9 years, 56% were women, Kellgren-Lawrence (KL) grade I through III (46% Kellgren-Lawrence status III), body mass index 27.2, and 4 years osteoarthritis anteriority. A post hoc comparison was performed using a single intra-articular injection placebo (326 patients, pooled from 3 randomized controlled trials) providing a similar patient profile. Results The main criterion was the variation from baseline of the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index, pain subscale (A) score (range 0-100), at 60 days, which was reduced by 28.9 (17.4) for the intent-to-treat population (199 patients), 28.0 (17.8) for the per protocol at inclusion population (175 patients), and by 27.7 (16.8) for the per protocol completed population (143 patients). The secondary and accessory criteria included WOMAC A score at the other times, WOMAC B (stiffness) score, WOMAC C (function) score, quality of life, and handicap at each follow-up time. All indexes were significantly improved and continued to improve at the end of the study. The therapeutic assessment at 180 days showed more than 75% of patients were satisfied with pain reduction, mobility improvement, and reduction in taking analgesics and nonsteroidal anti-inflammatory drugs. The percentage of patients defined as Outcome Measures in Rheumatology Clinical Trials–Osteoarthritis Research Society International Standing Committee for Clinical Trials Response Criteria Initiative (OMERACT-OARSI) responders was >86%, from 60 days onward. The overall tolerance was good, without any serious adverse event. The result of the post hoc comparison for the WOMAC A score showed an effect size from 0.33 (95% CI 0.15–0.51) at 60 days to 0.65 (95% CI 0.45–0.85) at 180 days (P < 0.001), versus injected placebo (saline solution), which is clinically relevant in favor of Arthrum 2.5%. Conclusions The present study suggests the clinical efficacy of a single intra-articular injection of 3 mL intra-articular hyaluronic acid solution containing 75 mg high molecular weight (>2 MDa) native hyaluronic acid.
Collapse
Affiliation(s)
- Dominique Baron
- Rhumatologue, Centre Hospitalier de Lannion, Lannion, France
| | - Christian Flin
- Médecin de Médecine Physique et Réadaptation, St Raphaël, France
| | | | | | | |
Collapse
|
21
|
Do intra-articular hyaluronic acid injections delay total knee replacement in patients with osteoarthritis - A Cox model analysis. PLoS One 2017; 12:e0187227. [PMID: 29155833 PMCID: PMC5695798 DOI: 10.1371/journal.pone.0187227] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 10/16/2017] [Indexed: 12/18/2022] Open
Abstract
Due to the growing worldwide prevalence of knee osteoarthritis, the optimal management of this issue is critical for reducing its burden.
Collapse
|