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Pyo E, Weber MB, Sivaram J, Staimez LR, Mohan V, Anjana RM, Haardörfer R, Ranjani H. Construct validity of the 12-item Short Form Health Survey (SF-12) version 2 and the impact of lifestyle modifications on the health-related quality of life among Indian adults with prediabetes: results from the D-CLIP trial. Qual Life Res 2024; 33:1593-1603. [PMID: 38607494 PMCID: PMC11226141 DOI: 10.1007/s11136-024-03648-6] [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] [Accepted: 03/08/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE This study aimed to validate the factor structure of the 12-item Short-Form (SF-12) health-related quality of life (HRQOL) survey for Indian adults and assess the impact of lifestyle modification on the SF-12 of Indian adults with prediabetes. METHODS To validate the context-specific construct of the SF-12, two-factor confirmatory factor analysis (CFA) was performed using data from 1285 adults residing in Chennai, India, who screened for the Diabetes Community Lifestyle Improvement Program (D-CLIP). D-CLIP was a randomized controlled trial of 578 participants with prediabetes (283 treatment, 293 control), focusing on the effect of lifestyle modifications on the prevention of diabetes. Physical and mental component scores (PCS and MCS) were computed by using CFA standardized factor loadings. Multiple linear regression was subsequently conducted to estimate the effect of lifestyle modification on post-study changes of PCS and MCS among D-CLIP participants. RESULTS Cronbach's alpha and CFA fit indices demonstrated acceptable reliability and model fit of the SF-12 for Indian adults. The intervention group showed greater mean change in PCS after study participation compared to the controls (1.63 ± 0.82, p = 0.046); no significant difference was observed for MCS between two groups (1.00 ± 0.85, p = 0.242). CONCLUSION The study confirmed that the SF-12 is suitable for assessing the physical and mental health dimensions of HRQOL for Indian adults. Our findings suggest that the benefits of diabetes prevention lifestyle modification strategies may primarily enhance the physical well-being of adults with prediabetes. Further studies validating the SF-12 in a broader Asian Indian population are needed. TRIAL REGISTRATION Clinicaltrials.gov, NCT01283308.
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Affiliation(s)
- Euisun Pyo
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, USA.
| | - Mary Beth Weber
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, GA, 30322, USA
| | | | - Lisa R Staimez
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, GA, 30322, USA
| | - Viswanathan Mohan
- Department of Diabetology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Ranjit Mohan Anjana
- Department of Diabetology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Regine Haardörfer
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Harish Ranjani
- Department of Preventive and Digital Health Research, Madras Diabetes Research Foundation, Chennai, India
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Babu A, Channaveera C, Gupta A, Mittal MK, Johnson DS. Clinical and radiological efficacy of single-dose intra-articular high-molecular-weight hyaluronic acid in knee osteoarthritis. J Family Med Prim Care 2023; 12:1692-1696. [PMID: 37767433 PMCID: PMC10521855 DOI: 10.4103/jfmpc.jfmpc_486_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 09/29/2023] Open
Abstract
Context While visco-supplementation is being used for the treatment of knee osteoarthritis (OA), the published reports vary widely in benefits afforded by this treatment. It was therefore proposed to assess the objective parameters along with subjective outcomes. Aims Our study assessed the radiological and clinical efficacy of single-dose high-molecular-weight intra-articular hyaluronic acid (HMW-IAHA) injection in knee OA. Settings and Design This interventional cohort study was conducted in a calculated sample size of 44 patients with knee OA. Materials and Methods Visual analog scale (VAS) and knee OA and outcome score (KOOS) were used for clinical assessment, and whole organ magnetic resonance imaging score (WORMS) for radiological assessment. The subjects were given a single dose of HMW-IAHA injection, 90 mg/3 ml, and were assessed on day 0 and day 90. Statistical Analysis Statistical Package for Social Sciences (SPSS) software was used. Results At the day 90 follow-up, there was an improvement in mean ± standard deviation values of VAS score (day 0: 8.53 ± 0.81, day 90: 5.97 ± 0.87), KOOS score (day 0: 27.33 ± 15.18, day 90: 57.26 ± 14.26), and the cartilage signal and morphology in the medial femorotibial joint (day 0: 11.02 ± 6.26 and day 90: 10.91 ± 6.22) and patellofemoral joint (day 0: 10.35 ± 4.36 and day 90: 10.28 ± 4.39) compartments. There was a decrease in synovitis score from 2.3 ± 1.61 to 1.3 ± 1.3 in the medial femorotibial joint compartment and total WORMS score (day 0: 66.57 ± 36.06, day 90: 65.14 ± 35.62). Conclusions A single dose of intra-articular injection with high-molecular-weight hyaluronic acid produces improvement in the clinical symptoms and quality of life as well as is effective in maintaining the articular cartilage integrity and reducing synovial inflammation.
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Affiliation(s)
- Anjana Babu
- Department of Physical Medicine and Rehabilitation, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India
| | - Chethan Channaveera
- Department of Physical Medicine and Rehabilitation, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, Delhi, India
| | - Ajay Gupta
- Department of Physical Medicine and Rehabilitation, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India
| | - Mahesh K. Mittal
- Department of Radiodiagnosis, Subharti Medical College, Meerut, Uttar Pradesh, India
| | - Deepthi S. Johnson
- Department of Physical Medicine and Rehabilitation, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India
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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.
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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
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Xue Y, Wang X, Wang X, Huang L, Yao A, Xue Y. A comparative study of the efficacy of intra-articular injection of different drugs in the treatment of mild to moderate knee osteoarthritis: A network meta-analysis. Medicine (Baltimore) 2023; 102:e33339. [PMID: 36961175 PMCID: PMC10036057 DOI: 10.1097/md.0000000000033339] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/01/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Knee osteoarthritis (KOA) has a high clinical prevalence and frequently interferes with patients normal lives. In KOA patients, evidence suggests that intra-articular (IA) injection improves joint function and decreases discomfort. Several IA injection treatments are used in daily practice to improve symptomatic control of knee osteoarthritis, but their efficacy is frequently disputed. METHODS This network meta-analysis compares the efficacy of different IA injections for mild to moderate knee osteoarthritis. Seven databases (PubMed, EMBASE, Web of Science, Cochrane Library, China Biology Medicine disc, WanFang, and China National Knowledge Infrastructure) were searched for randomized controlled trials published up to and including December 20, 2021, and final follow up indicators were used. Visual analogue scale (VAS) score and The Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index (WOMAC) score change from baseline were the primary outcomes. We used the Cochrane risk of bias tool to assess the quality and risks of biases of papers. We calculated the weighted mean difference (WMD) and 95% confidence interval (CI) for each outcome. State (Version 15.1, Texas, USA) and SPSS (Version 20, Chicago, USA) was used in all statistical analyses, and Review Manager (version 5.4) was used in assessing the risks of biases. RESULTS Our study included 16 randomized controlled trials with a total of 1652 patients. platelet-rich plasma (PRP) IA injection therapy had the highest likelihood of being the best intervention in reducing WOMAC pain (surface under the cumulative ranking area [SUCRA] 84.7%), stiffness (SUCRA 95.1%), and function (SUCRA 98.5%) scores, according to the SUCRA. The best measures for lowering the WOMAC total and VAS scores were IA injection platelet-rich plasma-derived growth factor (SUCRA 84.9%) and hyaluronic acid and platelet-rich plasma (SUCRA 84.9%). In the VAS score group, PRP outperformed hyaluronic acid (HA) (WMD 1.3, 95% CI 0.55-2.55) and corticosteroids (CS) (WMD 4.85, 95% CI 4.02-5.08), according to the forest map results. PRP also outperformed CS (WMD 14.76, 95% CI 12.11-17.41), ozone (WMD 9.16, 95% CI 6.89-11.43), and PRP + HA (WMD 2.18, 95% CI 0.55-3.81) in the WOMAC total score group. Furthermore, PRP outperforms other drugs in terms of reducing WOMAC function, stiffness, and function score. CONCLUSION In patients with mild to moderate KOA, IA injection PRP outperformed IA injection ozone, HA, CS, platelet-rich plasma-derived growth factor, and hyaluronic acid and platelet-rich plasma in terms of pain, stiffness, and dysfunction.
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Affiliation(s)
- Yuan Xue
- Shanxi University of Chinese Medicine, Taiyuan, Shanxi, China
| | - Xuan Wang
- Shanxi University of Chinese Medicine, Taiyuan, Shanxi, China
| | - Xiuming Wang
- Shanxi University of Chinese Medicine, Taiyuan, Shanxi, China
| | - Li Huang
- Shanxi University of Chinese Medicine, Taiyuan, Shanxi, China
| | - Aina Yao
- Shanxi Acupuncture and Moxibustion Hospital/Shanxi Institute of Acupuncture and Moxibustion, Taiyuan, Shanxi, China
| | - Yan Xue
- Northwest Women and Children’s Hospital, Xian, Shaanxi, China
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Alexandres Rios de Los Rios D, Guaschi Herretes A, Hernández Herrero D. [Analysis of reinjection periodicity in knee osteoarthritis with different types of hyaluronic acids]. Rehabilitacion (Madr) 2023; 57:100734. [PMID: 35527076 DOI: 10.1016/j.rh.2022.02.008] [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: 03/30/2021] [Revised: 12/29/2021] [Accepted: 02/13/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To evaluate the periodicity of hyaluronic acid (HA) reinjection in patients with knee osteoarthritis. Secondary aim: To relate the degree of arthrosis with the time between infiltrations and the possible study by subgroups between the different commercial preparations. DESIGN Retrospective observational study. MATERIALS AND METHOD Review of medical records and X-rays of patients with knee osteoarthritis that had been treated with intra-articular HA at the Rehabilitation Service in the period between January 2017 and June 2019. VARIABLES Socio-demographic, Laterality, Intervention Date, Degree of Arthrosis according to Kellgren and Lawrence, HA used, Time between filtrations. Statistical analysis carried out by Kaplan-Meier curves, taking into account the reinfiltration as final event, and Kruskal-Wallis test for non-parametric quantitative data. RESULTS We analysed 110 infiltration acts in 67 patients: average age at the time of infiltration 72.12 years, 85.1% women, 59.1% right knee. 4 types of HA: 33 cases at 1%. MW: 0.9MDa (HA1), 12 at 1.5%. MW: 1.5-2MDa (HA2), 42 at 2%. MW: 1.2MDa (HA3) and 6 Hylan G-F20. MW: 6MDa (HA4). We reinfiltrated in 31 occasions (28.2%). Average of months (IC 95%) between infiltrations: HA1 6.9 (5.7-8.16), HA2 12.5 (0-35), HA3 9.3 (5.5-13.1), HA4 5 (3-6.9). In 2 cases where it was not possible to establish the type of infiltrated formulations, the mean value between reinfiltrations was 8.5 (5.6-11.4) There were no statistically significant results by relating the HA type or the degree of arthrosis with the reinfiltration time. CONCLUSIONS In our study, we observe that the HA3 presented a longer time between infiltrations in comparison with other types, with no possibility to detect significant differences.
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Affiliation(s)
| | - A Guaschi Herretes
- Departamento de Medicina Física y Rehabilitación, Hospital Universitario La Paz, Madrid, España
| | - D Hernández Herrero
- Departamento de Medicina Física y Rehabilitación, Hospital Universitario La Paz, Madrid, España
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Acharya K, Si V, Madi S. Improvement in condition specific and generic quality of life outcomes in patients with knee osteoarthritis following single intraarticular viscosupplementation injection. J Clin Orthop Trauma 2022; 27:101828. [PMID: 35310785 PMCID: PMC8924687 DOI: 10.1016/j.jcot.2022.101828] [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: 11/27/2021] [Revised: 01/12/2022] [Accepted: 03/02/2022] [Indexed: 10/18/2022] Open
Abstract
Background Non-operative management of Osteoarthritis (OA) can be challenging. The intra-articular injection with hyaluronic acid (IAHA), corticosteroids and Platelet rich plasma are some of the popular modalities which are increasingly being employed as a stop-gap strategy before considering any surgical intervention for OA management. Among these, the intra-articular HA (IAHA) has been widely studied with variable and conflicting results. Method This was a prospective observational study conducted in adults with knee OA. Suitable patients were given IAHA (Synvisc-One®) on an out-patient basis. They were assessed in terms of VAS score, WOMAC score and SF36 scores at successive follow-up visits at 8, 24 and 52 weeks. Results 50 patients were recruited in this study and followed for 52 weeks post injection of HA. Mean and SD values of VAS, WOMAC and SF36 scores were on a decreasing trend in each follow up visit. Percentage change between the visits was also statistically significant. The improvement in pain scores at successive visits was significant in KL grade 1 OA than grade 2 or 3 indicating strong association between them. Conclusion Short-term (up to one year) beneficial effects of intra-articular viscosupplementation with HA in early primary knee OA can be seen with a decreasing trend in the intensity of pain and an increasing trend in improving the physical functioning and health-related quality of life.
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Affiliation(s)
| | | | - Sandesh Madi
- Corresponding author. Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India.
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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.
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Affiliation(s)
- Patrice Vincent
- Directeur R&D, LCA Pharmaceutical, 9 allée Prométhée, 28000 Chartres, France
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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.
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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)
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Affiliation(s)
- Patrice Vincent
- R&D manager, LCA Pharmaceutical, 9 allée Prométhée, 28000 Chartres, France
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Gavín C, J Blanco F, L Pablos J, Caracuel MA, Rosas J, Gómez-Barrena E, Navarro F, Coronel MP, Gimeno M. One-Year, Efficacy and Safety Open Label Study, with a Single Injection of a New Hyaluronan for Knee OA: The SOYA Trial. J Pain Res 2021; 14:2229-2237. [PMID: 34321921 PMCID: PMC8312328 DOI: 10.2147/jpr.s321841] [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: 05/25/2021] [Accepted: 07/06/2021] [Indexed: 01/07/2023] Open
Abstract
Purpose To assess the efficacy and safety of a single injection of a new formulation of hyaluronic acid (MPS-HA2%) in patients with symptomatic knee osteoarthritis after 12 months’ follow-up. Patients and Methods Prospective, single-arm, multicentre, open-label, 12-month follow-up study. Patients with Kellgren–Lawrence (KL) 2–3 and visual analogue scale (VAS) pain scores of ≥40–< 80 mm received a single injection of MPS-HA2%. The primary outcome was the reduction in VAS pain scores from baseline, and the secondary outcomes were the Western Ontario and McMaster (WOMAC) Universities Osteoarthritis Index, the minimum clinically important improvement (MCII), and patient and investigator global assessments (PGA, IGA) measured on 5-point Likert scale. Adverse events were recorded throughout the study for safety purposes. Results A total of 101 patients (mean age: 68 years; 74% female; and 78% overweight) were included. The mean reduction in pain at 12 months was 37.7%; the total WOMAC score improved by 36.5% and the pain, stiffness and physical function subscores returned improvements of 32.1%, 34.1% and 32.7%, respectively (p=0.0001 with respect to baseline). At 12 months, a statistically significant 62.2% of patients obtained an improvement equal to or greater than the MCII. The mean PGA score at baseline was 2.44 and 1.46 at 12 months (p<0.05), and the mean IGA scores at equivalent timepoints were 2.29 and 1.48 (p<0.05). Fourteen patients received a second injection at the 6-month follow-up visit. Eight patients reported a total of 12 treatment-related adverse events that were local, non-serious and of mild-to-moderate intensity. Conclusion With just a single intra-articular injection, this not controlled trial suggests that MPS-HA2% is effective 12 months after the procedure in most cases. Patient tolerability and safety were both optimal (NCT03852914).
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Affiliation(s)
- Carlos Gavín
- Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | | | | | | - José Rosas
- Hospital Marina Baixa, Villajoyosa, Alicante, Spain
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Pavelka K, Horváth R, Hurnáková J, Saracino L, Giordan N, Procházková L, Moster E, Dokoupilová E. Clinical effectiveness and safety of intra-articular injection of HYALGO in the management of knee osteoarthritis symptoms: A multicenter prospective study. J Clin Orthop Trauma 2021; 19:75-80. [PMID: 34099970 PMCID: PMC8165427 DOI: 10.1016/j.jcot.2021.05.009] [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: 01/14/2021] [Revised: 04/29/2021] [Accepted: 05/12/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The reduced concentration of hyaluronic acid in the synovial fluid, leading to impairment of joint function and painful symptomatology during knee osteoarthritis (OA), can be restored by using injectable formulations of hyaluronic acid (HA) and chondroitin sulfate (CS), variable for relative composition, HA/CS molecular modifications, and injection protocols. The present study aims to assess the safety and performance of the intra-articular (IA) viscosupplementing agent HYALGO, a formulation combining 40 mg/mL HA (>1700 kDa) and 40 mg/mL CS, in the treatment of patients suffering from knee OA. METHODS 74 patients affected by knee lesions classified as grade II and III according to Kellgren and Lawrence classification were prospectively recruited and treated with three HYALGO injections (2 mL) given one week apart. Visual analogue scale (VAS) pain changes were monitored at each injection and over-time at 6, 14, and 26 weeks of follow-up. Secondary endpoints were: Western Ontario McMaster University Osteoarthritis index (WOMAC), Patient's Global Assessment (PGA) score, Clinical Observer Global Assessment (COGA) score, Outcome Measures in Rheumatology Committee (OMERACT) and Osteoarthritis Research Society International (OARSI) responders rates. Patients were also assessed for changes in their ultrasound joint scores according to the criteria of the OMERACT US Task Force Group. RESULTS Pain reduction was statistically significant starting from the first IA injection. Mean pain reduction from baseline to week 26 was -90.6%. At 26 weeks, WOMAC Pain was reduced by -62.7%, WOMAC Stiffness by -47.2%, WOMAC Physical Function by -54.1%; Total WOMAC by -53.8%. The VAS PGA change from baseline was -48.0 [mm] and VAS COGA -41.0 [mm]. Responders at week 26 were 78.4%. Ultrasound parameters (joint effusion, synovial thickness, and popliteal cysts) improved or remained stable from baseline to week 6. CONCLUSIONS Three injections of HYALGO were safe and effective to manage symptomatic knee OA, with a beneficial effect that increased progressively over time, peaking 6 months after injection.
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Affiliation(s)
- Karel Pavelka
- Institute of Rheumatology, Prague, Czech Republic,Corresponding author. Institute of Rheumatology, Na Slupi 4, Prague 2, 12850, Czech Republic.
| | - Rudolf Horváth
- Department of Paediatric and Adult Rheumatology, University Hospital Motol, Prague, Czech Republic
| | - Jana Hurnáková
- Institute of Rheumatology, Prague, Czech Republic,Department of Paediatric and Adult Rheumatology, University Hospital Motol, Prague, Czech Republic
| | | | | | | | - Erik Moster
- Revmacentrum MUDr. Mostera, s.r.o, Brno – Židenice, Czech Republic
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Ke Y, Jiang W, Xu Y, Chen Y, Zhang Q, Xue Q, Lin J, Ngai W, Nian G, Fazeli MS, Xie Y, Zhu Z. Efficacy and safety of a single intra-articular injection of 6 ml Hylan G-F 20 compared to placebo in Chinese patients with symptomatic knee osteoarthritis : C-SOUND study, a 26-week multicenter double-blind randomized placebo-controlled trial in China. BMC Musculoskelet Disord 2021; 22:428. [PMID: 33964907 PMCID: PMC8106861 DOI: 10.1186/s12891-021-04252-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 04/13/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Single 6 ml Hylan G-F 20 injection, is indicated for knee osteoarthritis patients who have failed to respond to non-pharmacologic therapy and/or simple analgesics. To obtain more thorough understanding of the clinical efficacy and safety, a randomized clinical trial was conducted comparing intra-articular (IA) administration of single 6 ml Hylan G-F 20 injection versus placebo in knee OA patients of Chinese ethnicity. METHODS This was a randomized, multi-center, double-blind, placebo-controlled clinical trial conducted in 21 centers across China. Four hundred forty adults with knee OA received a single 6 ml Hylan G-F 20 or placebo injection and were evaluated for clinical efficacy and safety outcomes over 26 weeks. Western Ontario and McMaster Universities OA (WOMAC) A1 index, treatment-emergent adverse events (TEAEs) and standard safety parameters were measured at pre-injection, and at weeks 1, 4, 8, 12, 16, 20 and 26 post-injection. RESULTS Four hundred forty patients (male: 98 [22.3%]; female: 342 [77.7%]) were randomized. The mean age [standard deviation (SD)] was 61.5 (7.9) years. All patients were of East Asian ethnicity. Mean WOMAC A1 score at baseline was 5.3 (1.2) and 5.2 (1.3) in single 6 ml Hylan G-F 20 injection and placebo groups, respectively. Significant reductions of WOMAC A1 score were observed in both treatment groups when compared to baseline at 26 weeks post-injection, with the mean reduction of [standard error (SE)/percentage] -2.146 (0.108)/- 40.5% and - 2.271 (0.110) /- 43.7% in the single 6 ml Hylan G-F 20 injection and the placebo groups, respectively. Additionally, clinically important reductions in pain at 26 weeks was reported in 67.0 and 68.2% in single 6 ml Hylan G-F 20 injection and placebo groups (p = 0.36). Regarding safety, TEAEs were similar between the two treatment groups (hylan G-F 20 single: 61.5%; placebo: 64.5%). CONCLUSIONS While the magnitude of the effect of a single 6 ml Hylan G-F 20 injection in this study is consistent with previously published literature with respect to the efficacy and safety of the drug, the current study shows a strong IA placebo effect and did not established superiority of single 6 ml Hylan G-F 20 injection over IA placebo in Chinese knee OA patients. TRIAL REGISTRATION Prospectively registered Jun 16, 2017 at www.clinicaltrials.gov ( NCT03190369 ).
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Affiliation(s)
- Yan Ke
- Peking University People's Hospital, Beijing, China
| | | | - Yongsheng Xu
- Inner Mongolia People's Hospital, Hohhot City, China
| | - Yajun Chen
- Tianjin Medical University General Hospital, Tianjin, China
| | - Qingsong Zhang
- Wuhan Fourth People's Hospital; Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | - Jianhao Lin
- Peking University People's Hospital, Beijing, China
| | | | | | - Mir Sohail Fazeli
- Evidinno Outcomes Research Inc., Vancouver, British Columbia, Canada
| | - Yao Xie
- Sanofi China, Shanghai, China
| | - Zhenan Zhu
- Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No.639 Zizaoju Road, Huangpu District, Shanghai, China.
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12
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More S, Kotiya A, Kotia A, Ghosh SK, Spyrou LA, Sarris IE. Rheological properties of synovial fluid due to viscosupplements: A review for osteoarthritis remedy. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 196:105644. [PMID: 32645531 DOI: 10.1016/j.cmpb.2020.105644] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/30/2020] [Indexed: 06/11/2023]
Abstract
The synovial fluid is a transparent electrolyte solution included in joints to provide lubrication helping the proper movement. It exhibits complex rheological properties due to the interaction among its constituents i.e. hyaluronic acid, albumin, lubricin and phospholipids. In degenerative osteoarthritis and inflammatory rheumatoid arthritis diseases, the quantity of synovial fluid and lubrication efficiency significantly deteriorates. In that case, viscosupplementation with intra-articular hyaluronic acid may be prescribed to replenish the concentration, the molecular weight and the rheological properties of natural synovial fluid. The present review concentrates on the recent advancements in viscosupplementation with emphasis into their rheological properties, its effects on the rheological behavior of synovial fluid, and finally its clinical effectiveness. Initially, the properties of synovial fluid are summarized, and then a discussion on commercial viscosupplements, the role of polymeric properties and their rheological properties are reviewed. Moreover, a detailed discussion on the clinical effectiveness and challenges of viscosupplements are provided.
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Affiliation(s)
- S More
- School of Mechanical Engineering, Lovely Professional University, Punjab, India
| | - A Kotiya
- Central Research Institute (H), Noida, India
| | - A Kotia
- School of Mechanical Engineering, Lovely Professional University, Punjab, India
| | - S K Ghosh
- Indian Institute of Technology (Indian School of Mines) Dhanbad, India
| | - L A Spyrou
- Institute for Bio-Economy and Agri-Technology, Center for Research and Technology Hellas, 38333 Volos, Greece
| | - I E Sarris
- Department of Mechanical Engineering, University of West Attica, 12210 Athens, Greece.
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13
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De Lucia O, Jerosch J, Yoon S, Sayre T, Ngai W, Filippou G. One-year efficacy and safety of single or one to three weekly injections of hylan G-F 20 for knee osteoarthritis: a systematic literature review and meta-analysis. Clin Rheumatol 2020; 40:2133-2142. [PMID: 33108530 PMCID: PMC8121739 DOI: 10.1007/s10067-020-05477-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 12/30/2022]
Abstract
The aim of this study was to evaluate the long-term efficacy and safety of single or 1–3 weekly injections of hylan G-F 20 at 1 year following the first injection for knee osteoarthritis (OA). Searches were conducted in PubMed/MEDLINE, Embase, and CENTRAL and included relevant conference proceedings (January 1, 1995–August 17, 2020). Randomized controlled trials (RCTs), non-randomized trials, and observational studies investigating 1-year efficacy and safety of 1–3 weekly injections or single hylan G-F 20 injection for knee OA were included. Primary outcomes were WOMAC pain, physical function, and stiffness. Meta-analyses of RCTs and non-randomized studies were conducted separately. Our search identified 24 eligible studies. Hylan G-F 20, in the meta-analyses of RCTs, showed statistically significant improvement in WOMAC pain (SMCC − 0.98, 95% CI − 1.50, − 0.46), physical function (SMCC − 1.05, 95% CI − 1.28, − 0.83), and stiffness (SMCC − 1.07, 95% CI −1.28, −0.86). Improvement was also seen for VAS pain, SF-36 MCS (mental component summary), and SF-36 PCS (physical component summary). Analyses of non-randomized studies showed similar efficacy estimates. There were no significant differences in efficacy based on injection schedule, nor between RCT and non-randomized studies. Rates of adverse events (AEs) were low for most types of AEs. Hylan G-F 20 (either as single or 1–3 weekly injections) showed improvement in 1-year efficacy outcomes in comparison to baseline and was generally well tolerated. While further research will inform the medical field regarding viscosupplementation treatment options for knee OA, these findings show that hylan G-F 20 at both frequencies/dosages are efficacious and generally well tolerated for long-term use.
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Affiliation(s)
- Orazio De Lucia
- Clinical Rheumatology Unit, Department of Rheumatology and Medical Sciences, ASST Centro Traumatologico Ortopedico G. Pini-CTO, Milan, Italy
| | - Joerg Jerosch
- Orthopedic Department, Johanna Étienne Hospital, Am Hasenberg 46, 41462, Neuss, Germany
| | | | | | - Wilson Ngai
- Global Medical Affairs, Sanofi, Bridgewater, NJ, USA
| | - Georgios Filippou
- ASST Fatebenefratelli, University Hospital "Luigi Sacco", Rheumatology Unit, Via Giovanni Battista Grassi, 74, 20157, Milan, Italy.
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14
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Raeissadat SA, Gharooee Ahangar A, Rayegani SM, Minator Sajjadi M, Ebrahimpour A, Yavari P. Platelet-Rich Plasma-Derived Growth Factor vs Hyaluronic Acid Injection in the Individuals with Knee Osteoarthritis: A One Year Randomized Clinical Trial. J Pain Res 2020; 13:1699-1711. [PMID: 32753945 PMCID: PMC7354951 DOI: 10.2147/jpr.s210715] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 05/27/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE In this study, we aimed at performing a comparison between intra-articular injections of PRP-derived growth factor (PGRF) and hyaluronic acid regarding their effect on pain and patient's function in knee osteoarthritis, as well as their safety profiles. METHODS During our single-masked randomized clinical trial, the candidates with symptomatic knee osteoarthritis received two intra-articular injections of PRGF with 3 weeks apart or received three weekly injections of HA. The mean improvements from before treatment until the second, sixth, and twelfth months post-intervention in scores obtained by visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Lequesne index were our primary outcomes. RESULTS A total of 102 candidates were finally included in the study. Patients' mean age was 57.08±7.3 years old in the PRGF group compared to the mean age of 58.63±7.09 years old in HA patients. In the PRGF group, total WOMAC index decreased from 41.96±11.71 to 27.10±12.3 (P = 0.02), and from 39.71±10.4 to 32.41±11.8 in the HA group after 12 months (P > 0.05). Regarding the Lequesne index, pain, ADL, and global scores significantly decreased after 12 months in the PRGF group compared to the HA group (P<0.001). There was also a meaningful higher rate of satisfaction in the PRGF group compared to the HA group after 12 months of treatment (P<0.001). CONCLUSION Besides significantly higher satisfaction belonging to the PRGF group, there was a statistically significant improvement in VAS score and global, pain, and ADL score of Lequesne by passing 12 months from injection in PRGF compared to HA.
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Affiliation(s)
- Seyed Ahmad Raeissadat
- Physical Medicine and Rehabilitation Research Center, Clinical Research Development Center of Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Seyed Mansoor Rayegani
- Physical Medicine and Rehabilitation Research Center, Clinical Research Development Center of Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Adel Ebrahimpour
- Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pegah Yavari
- Physical Medicine and Rehabilitation Research Center, Clinical Research Development Center of Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Vincent P. Injections intra articulaires (IA) d'acide hyaluronique (AH) dans le traitement symptomatique de la gonarthrose : une méta-analyse des injections uniques (mono-injections). Curr Ther Res Clin Exp 2019; 91:52-65. [PMID: 31871509 PMCID: PMC6911907 DOI: 10.1016/j.curtheres.2019.100569] [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: 10/09/2019] [Accepted: 10/09/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction La viscosupplémentation du liquide synovial par injections intra articulaires (IA) d'acide hyaluronique (AH), est un traitement symptomatique bien connu dans la gonarthrose. La question se pose de savoir si les traitements par injection unique (mono-injection) peuvent présenter autant d'efficacité que les multi-injections (3 à 5). Méthodes Une méta-analyse des résultats publiés pour les essais de mono-injections IA de AH a été réalisée. Le critère d'efficacité retenu a été le sous-score douleur de l'indice Western Ontario and MacMaster universities (WOMAC A). Toutes les conceptions d'études ont été admises, depuis les essais randomisés contrôlés jusqu'aux études observationnelles ouvertes à simple bras. Une recherche extensive a été effectuée à partir de PubMed, Google, Google Scholar, et des listes de références trouvées dans les méta-analyses récentes, pour obtenir tous les articles publiés avant fin avril 2018. Les profils des populations furent analysés en termes d'âge, de sexe, d'indice de masse corporelle (IMC) et de stade radiologique selon Kellgren-Lawrence (KL). Les résultats d'injection IA unique de placebo, ont été pris en compte pour créer une base permettant des comparaisons post-hoc. Chaque bras AH IA étudié a été comparé à un bras placebo IA (seul ou mixé), de manière à présenter un profil KL similaire, contrôlé à l'aide du test Chi2. Les tailles de l'effet (ES) avec intervalles de confiance (IC 95%) et p-valeurs furent calculées et synthétisées pour chacune des visites de contrôle à 1, 2, 3 et 6 mois. En parallèle, une approche globale a été utilisée afin de représenter les variations par rapport à la baseline, pour chacun des sous-groupes étudiés. Résultats En partant de 1 547 citations, 28 études ont été incluses dans la méta-analyse, décrivant 4 129 patients traités par mono-injection: 3 360 ont reçu de l'AH IA et 769 patients ont reçu du placebo IA. Le patient moyen (SD) traité par AH IA était âgé de 61,2 (9,6) ans dont 63% de femmes, avec un IMC de 28,0 (4,1) kg/m2, et un stade radiologique à 47% KL III pour 3% KL IV. Un bon appariement du profil KL a été obtenu pour 26 des 31 bras AH IA. Sur l'ensemble de la population AH IA, ES = 0,30 (0,25; 0,35) à 3 mois et ES = 0,39 (0,33; 0,44) à 6 mois. Dans une analyse restreinte, après élimination des cas aberrants, des KL mal appariés et des bras actifs < 30 patients, les résultats sont restés inchangés, ES = 0,29 (0,23; 0,34) et ES = 0,40 (0,34; 0,45) à 3 et 6 mois respectivement, tandis que l'hétérogénéité était améliorée. Discussion Il existe certainement des limites à la méthode de comparaison post-hoc versus placebo, appliquée à des essais individuels. Mais pour chaque synthèse par sous-groupe ou groupe, les résultats ont été confirmés en utilisant plusieurs approches statistiques et différentes méthodes de pondération. Cette méta-analyse suggère que les résultats des mono-injections sont similaires à ceux des multi-injections d'acide hyaluronique intra articulaire en termes de soulagement de la douleur, dans le traitement de la gonarthrose.
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Key Words
- AH, Acide Hyaluronique (ou hyaluronate de sodium)
- ES, Taille d'effet (« d » de Cohen)
- IA, Intra articulaire
- IC, Intervalle de Confiance
- IMC, Indice de Masse Corporelle (Kg/m2)
- KL, Kellgren-Lawrence (Echelle radiologique de l'arthrose)
- La viscosupplémentation
- MCID, Différence Minimale Cliniquement Importante
- MD, Différence Moyenne
- MSC, Cellules Souche Mésenchymateuses
- NA, Non disponible (donnée manquante)
- NS, Non significatif
- OA, Ostéoarthrose
- PRGF, Plasma Riche en Facteurs de Croissance
- PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses
- PRP, Plasma Riche en Plaquettes
- RCT, Essai Contrôlé Randomisé
- SD, Ecart-type
- SDD, Plus Petite Différence Détectable
- SE, Erreur-type
- SMD, Différence Moyenne Standardisée
- UE, Union Européenne
- VS, Viscosupplémentation
- WOMAC, Western Ontario & McMaster universities
- la gonarthrose
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Affiliation(s)
- Patrice Vincent
- Correspondence to: Patrice Vincent, 9 allée Prométhée, 28000 Chartres, France
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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.
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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
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Vincent P. Intra-Articular Hyaluronic Acid in the Symptomatic Treatment of Knee Osteoarthritis: A Meta-Analysis of Single-Injection Products. Curr Ther Res Clin Exp 2019; 90:39-51. [PMID: 31289603 PMCID: PMC6591794 DOI: 10.1016/j.curtheres.2019.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 02/25/2019] [Indexed: 01/06/2023] Open
Abstract
Background Viscosupplementation of the synovial fluid with intra-articular hyaluronic acid (IA HA) is a well-known symptomatic treatment of knee osteoarthritis. The question arises whether a monoinjection (ie, single injection) could be as efficient as multi-injection (ie, 3-5 injections) regimens. Methods A meta-analysis of published studies relating to IA HA monoinjection trials was performed. The efficacy criterion was the Western Ontario and MacMaster Universities pain subscore. Any study design was accepted, from randomized control trials to single-arm observational open-label studies. An extensive search was performed using PubMed, Google, Google Scholar, and references found in recent meta-analyses, for all articles published before end of April 2018. Population profiles were analyzed in terms of age, sex, body mass index (BMI), and Kellgren-Lawrence (KL) radiology grades. Results of intra-articular single injection of placebo were collected to create a database allowing post hoc comparisons. Each IA HA study arm was compared to an IA placebo arm (either pooled or not), to present a similar KL profile controlled with the χ2 test. The effect size (ES) (95% CI) and P values were calculated and synthesized for each follow-up visit at 1, 2, 3, and 6 months. In parallel, a global approach was used to represent the variations from baseline for each group or subgroup studied. Results From 1547 citations, 28 studies were included in the meta-analysis, representing 4129 patients treated with monoinjection: 3360 received IA HA and 769 patients received IA placebo. The mean (SD) IA HA patient was 61.2 (9.6) years, 63% women, BMI 28.0 (4.1), 47% KL III, and 3% KL IV. A good placebo KL profile matching was obtained for 26 of the 31 IA HA arms. For the whole IA HA population, ES = 0.30 (95% CI, 0.25-0.35) at 3 months and ES = 0.39 (95% CI, 0.33-0.44) at 6 months. In a restricted analysis, after removal of outliers, poorly KL matched and active arms <30 patients, results remained unchanged, ES = 0.29 (95% CI, 0.23-0.34) and ES = 0.40 (95% CI, 0.34-0.45) at 3 and 6 months respectively, whilst heterogeneity was improved. Conclusions There are certainly limits to the post hoc placebo comparison method, for individual studies. But for each synthesis per subgroup or group, the results were properly confirmed using multiple statistical approaches and weighing methods. This meta-analysis suggests that monoinjections produce results similar to multi-injections of IA HA in terms of pain relief in the treatment of knee osteoarthritis. (Curr Ther Res Clin Exp. 2019; 80:XXX-XXX).
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Affiliation(s)
- Patrice Vincent
- LCA Pharmaceutical, 9 allée Prométhée, 28000 Chartres, France
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Abstract
Knee osteoarthritis is a chronic degenerative joint disease characterized by destruction of articular cartilage with resultant para-articular bone changes. It is a major cause of disability in older persons and is managed by surgical and nonsurgical interventions. Pharmacotherapy includes acetaminophen, nonsteroidal anti-inflammatory agents, and intra-articular steroids. Another treatment option is viscosupplementation with intra-articular injection of hyaluronan (HA). The full mechanism of action of exogenous HA is uncertain, but studies indicate that it may promote endogenous HA production, reduce inflammation, prevent degeneration of cartilage and promote cartilage regeneration. Clinically, HA may improve symptoms of osteoarthritis and delay time to total knee replacement surgery. However, clinical studies are heterogenous and of varying quality, and thus there is a need for more robust studies to determine the place of viscosupplementation in the management of knee osteoarthritis.
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Affiliation(s)
- David Webb
- Pattacus Medical, Randburg, South Africa
| | - Poobalan Naidoo
- Medical Affairs, Sanofi House, Midrand, South Africa, .,Department of Health Informatics, School of Health Professions, Rutgers, State University of New Jersey, NJ, USA,
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Altman R, Hackel J, Niazi F, Shaw P, Nicholls M. Efficacy and safety of repeated courses of hyaluronic acid injections for knee osteoarthritis: A systematic review. Semin Arthritis Rheum 2018; 48:168-175. [DOI: 10.1016/j.semarthrit.2018.01.009] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 01/11/2018] [Accepted: 01/16/2018] [Indexed: 12/12/2022]
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Kearey P, Popple AE, Warren J, Davis T, Bellamy N. Improvement in condition-specific and generic quality of life outcomes in patients with knee osteoarthritis following single-injection Synvisc: results from the LOBRAS study. Curr Med Res Opin 2017; 33:409-419. [PMID: 27848271 DOI: 10.1080/03007995.2016.1260533] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of viscosupplementation with single-injection hylan G-F20 (Synvisc-One) in knee osteoarthritis (OA), during routine clinical care, in a 52 week observational study. RESEARCH DESIGN AND METHODS The LOBRAS study involved a 1 year long, multi-center, quasi-experimental, repeated measures, observational study. Consenting patients in Australia fulfilling inclusion/exclusion criteria under the care of a medical specialist in routine clinical practice were enrolled. Prior to, and for 52 weeks following, intra-articular single-injection hylan G-F20, patients were repeatedly evaluated using the WOMAC NRS4.1 Index and the SF-36 questionnaire. The WOMAC NRS4.1 was administered by mobile phone (with paper back-up), and the SF-36 was administered on paper. Patients were monitored for adverse events. MAIN OUTCOME MEASURES Western Ontario and McMaster (WOMAC) OA Index, and the Short Form 36 questionnaire (SF-36 v2). RESULTS A total of 131 patients with knee OA were enrolled, of whom 119 provided both pre- and post-intervention WOMAC data. Statistically significant improvements (with a maximum of p ≤ .025) from baseline to Week 12, Month 6 and Week 52 were detected, by intention-to-treat (ITT) and per-protocol (PP) analyses, in WOMAC Pain, Stiffness, Function, PGA, and Total Score, SF-36 PCS, and WOMAC-derived HUI3. Adverse event (AE) monitoring detected treatment-related AEs in 5.3% of patients. CONCLUSIONS The effectiveness of single-injection hylan G-F20 in routine clinical care is supported by the detection of statistically significant, clinically important improvements in WOMAC Pain, Stiffness, Function, Total, and PGA outcomes, and statistically significant improvements in SF-36 PCS and WOMAC-derived HUI3 outcomes at multiple time points. Limitations of this study include lack of a control group or blinding. No predictive indicators of the response to treatment were identified. In general single-injection hylan G-F20 was well tolerated with very few patients experiencing any treatment-related adverse events. Collectively, these observations attest to the effectiveness of single-injection hylan G-F20 and complement previous observations in routine clinical care.
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Affiliation(s)
- P Kearey
- a School of Medicine , The University of Queensland , Brisbane , Australia
| | - A E Popple
- a School of Medicine , The University of Queensland , Brisbane , Australia
| | - J Warren
- b Recover Injury Research Centre , The University of Queensland , Brisbane , Australia
| | - T Davis
- c Exco InTouch , Nottingham , United Kingdom
| | - N Bellamy
- a School of Medicine , The University of Queensland , Brisbane , Australia
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Valutazione Economica Sull'utilizzo Del Plasma Arricchito di Piastrine VsAcido Ialuronico Per il Trattamento Dell'osteoartrosi al Ginocchio. Scenario a 1 Anno e a 5 Anni. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2017. [DOI: 10.5301/grhta.5000245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Heger R, Paulsen G, Fickert U, Kresmann M. Open-label Study of Initial and Repeat Treatment Cycles of Hylan G-F 20 in Patients with Symptomatic Knee Osteoarthritis. Open Rheumatol J 2016; 10:88-100. [PMID: 27867433 PMCID: PMC5101633 DOI: 10.2174/1874312901610010088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 09/30/2016] [Accepted: 10/13/2016] [Indexed: 12/18/2022] Open
Abstract
Objective: To evaluate the efficacy and safety of initial and repeat treatment with hylan G-F 20 in patients with symptomatic osteoarthritis (OA) of the knee. Methods: A prospective, multicenter, open-label study in adult patients with symptomatic knee OA (Kellgren-Lawrence grades I-III) undergoing repeat (SC group) or initial (IC group) treatment courses (3 x 2 mL of hylan G-F 20 at weekly intervals) was conducted with a maximum follow-up of 26 weeks. Reduction of pain using the Verbal Pain Questionnaire (VPQ) and Patient Global Assessment (PTGA) scores, concomitant pain medications use, and adverse events (AEs) were evaluated. Results: A total of 842 patients were included (SC group, n=314; IC group, n=528), of whom 616 formed the intent-to-treat (ITT) population (SC group, n=235; IC group, n=381). Of the 462 patients with follow-up at week 26, 311 (67.3%) were defined as responders. In the ITT population, VPQ scores decreased significantly at 26 weeks (p<0.001) compared with baseline. VPQ and PTGA scores decreased significantly (p<0.001) from baseline at all time points, without any significant changes in concomitant medication use. Twenty-four treatment-related AEs (TEAEs) were reported in 2.9% of patients, with most being mild or moderate in intensity and resolving without sequelae. Conclusion: Initial and repeat courses of hylan G-F 20 were effective with a favorable safety profile for knee OA. The large patient population and the study’s pragmatic design suggest that these results could be replicated in routine clinical practice.
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Affiliation(s)
- Robert Heger
- Praxis für Orthopädie, Eltinger Straße 56 71229 Leonberg, Germany
| | - Günther Paulsen
- Chirurgische Gemeinschaftspraxis, Katharinenstr 34, 75031 Eppingen, Germany
| | - Ulrich Fickert
- Chirurgische Praxis, Am Kutzschenstein 2, 01591 Riesa, Germany
| | - Michael Kresmann
- Gemeinschaftspraxis für Orthopädie, Bahnhofsallee 20, 40721 Hilden, Germany
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Pashuck TD, Kuroki K, Cook CR, Stoker AM, Cook JL. Hyaluronic acid versus saline intra-articular injections for amelioration of chronic knee osteoarthritis: A canine model. J Orthop Res 2016; 34:1772-1779. [PMID: 26867692 DOI: 10.1002/jor.23191] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 02/08/2016] [Indexed: 02/04/2023]
Abstract
The objective of this study was to assess the safety and efficacy of intra-articular injections of hyaluronic acid (HA) versus saline for symptomatic treatment of osteoarthritis (OA). Twenty-five adult purpose-bred dogs underwent meniscal release of one knee. Clinical, arthroscopic, and radiographic signs of OA were confirmed in all dogs prior to treatment. Dogs were randomized into five groups: HA-1 (n = 5), HA-3 (n = 5), HA-5 (n = 5), Saline-1 (n = 5), and Saline-3 (n = 5). Each dog received intra-articular injections of the respective substance into the affected knee at the pre-determined time points. Dogs were assessed for heat, swelling, and erythema after each injection and for lameness, pain, effusion, range of motion, kinetics, radiographic OA scoring, and arthroscopic scoring prior to treatment and for 6 months after injection. Dogs were then humanely euthanatized and the knees assessed grossly and histologically. Only mild heat, swelling, and/or erythema were noted in some dogs following injection and resolved within 1 week. Dogs treated with HA-1, HA-3, and HA-5 were significantly (p < 0.05) better than dogs treated with Saline-1 and Saline-3 at the 4, 8, and 12 week time points based on at least one outcome measure. OA severity was not significantly different among groups at any time point, but increased in severity over time in all groups. Gross and histologic OA scores were not significantly different among groups. These data suggest the three HA injection protocols were safe, superior to saline for short-term amelioration of symptoms associated with chronic OA, and can be translated to human OA treatment. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1772-1779, 2016.
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Affiliation(s)
- Troy D Pashuck
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Keiichi Kuroki
- Comparative Orthopaedic Laboratory, University of Missouri, Missouri Orthopaedic Institute (4028A), 1100 Virginia Ave., Columbia, 65212, Missouri
| | - Cristi R Cook
- Comparative Orthopaedic Laboratory, University of Missouri, Missouri Orthopaedic Institute (4028A), 1100 Virginia Ave., Columbia, 65212, Missouri
| | - Aaron M Stoker
- Comparative Orthopaedic Laboratory, University of Missouri, Missouri Orthopaedic Institute (4028A), 1100 Virginia Ave., Columbia, 65212, Missouri
| | - James L Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri. .,Comparative Orthopaedic Laboratory, University of Missouri, Missouri Orthopaedic Institute (4028A), 1100 Virginia Ave., Columbia, 65212, Missouri.
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Effect on Pain and Symptoms of Aspiration Before Hyaluronan Injection for Knee Osteoarthritis: A Prospective, Randomized, Single-blind Study. Am J Phys Med Rehabil 2016; 95:366-71. [PMID: 26488145 DOI: 10.1097/phm.0000000000000403] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The main objective of this study was to observe whether synovial fluid aspiration of the knee joint compared to no aspiration, before and after 5 weekly injections of intra-articular hyaluronan, provides an improvement in knee pain and physical function. DESIGN Patients were randomized to an arthrocentesis group (n = 92) or a nonarthrocentesis group (n = 88). In the arthrocentesis group, knee joints were maximally aspirated before each hyaluronan administration. In the nonarthrocentesis group, synovial fluid was not removed. Hyaluronan was injected into the knee joints once a week for 5 weeks. Patients were followed up for 25 weeks. Outcome measures included patient pain (using the 100-mm visual analog scale [VAS] during a 50-foot walking test), Western Ontario McMaster University Osteoarthritis Index (WOMAC) function scores, and overall effectiveness evaluated by patients and investigators on a scale of 1 to 6. RESULTS The arthrocentesis group showed significantly greater improvement from baseline to week 25 in VAS pain (P < 0.001) and WOMAC function scores (P < 0.001) than the nonarthrocentesis group. However, the differences of patient and investigator assessment of effectiveness did not achieve significance. CONCLUSIONS Synovial fluid drainage before injection of intra-articular hyaluronan significantly improved VAS pain and WOMAC function scores in patients with knee osteoarthritis, however, the differences of patient and investigator assessment did not achieve significance.
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Petrella RJ, Wakeford C. Pain relief and improved physical function in knee osteoarthritis patients receiving ongoing hylan G-F 20, a high-molecular-weight hyaluronan, versus other treatment options: data from a large real-world longitudinal cohort in Canada. DRUG DESIGN DEVELOPMENT AND THERAPY 2015; 9:5633-40. [PMID: 26508838 PMCID: PMC4610793 DOI: 10.2147/dddt.s88473] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
From the Southwestern Ontario database, one of the largest primary-care datasets in Canada, 1,263 patients with osteoarthritis (OA) of one or both knees were identified who received two consecutive series of intra-articular (IA) injections of hylan G-F 20 preparation and no other prescribed OA medications, and were evaluated fully between 2006 and 2012. A cohort of 3,318 demographically matched OA patients who had not been treated with IA injection therapy was identified from the same database for comparison. Responses to therapy were assessed by means of a 10-point visual analog scale (VAS) for pain at rest and after completion of a 6-minute walk test (6MWT), while physical capacity was measured by performance in the 6MWT itself. After two cycles of hylan G-F 20 therapy, the average VAS score for pain at rest declined from 7.82±1.27 at baseline to 4.16±1.51 (average change 3.66±1.78, significantly more than the reduction of 3.12±2.03 seen in the reference group [P<0.012]) and the average VAS score for pain after the 6MWT decreased by 5.56±1.74 points (from 9.58±0.4 at baseline to 4.02±1.67 at the final assessment), a significantly larger change than that seen in the reference group (Δ2.99±1.85; P<0.001 for intergroup comparison). Distance walked in the 6MWT increased on average by 115 m, significantly more than that seen in the reference group (Δ91 m; P<0.001 for intergroup comparison). These findings from a primary-care database suggest sustained benefits in terms of pain and physical function from repeat cycles of IA injections of hylan G-F 20 and no other prescribed OA medications in adults with OA of the knee.
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Affiliation(s)
- Robert J Petrella
- Departments of Family Medicine, Medicine (Cardiology) and Kinesiology, University of Western Ontario, London, ON, Canada ; Aging, Rehabilitation & Geriatric Care Research Centre, Lawson Health Research Institute, London, ON, Canada
| | - Craig Wakeford
- Health Economics and Health Outcomes, Sanofi-Aventis Inc., Laval, QC, Canada
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Posnett J, Dixit S, Oppenheimer B, Kili S, Mehin N. Patient preference and willingness to pay for knee osteoarthritis treatments. Patient Prefer Adherence 2015; 9:733-44. [PMID: 26089650 PMCID: PMC4468999 DOI: 10.2147/ppa.s84251] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To review treatments for osteoarthritis of the knee (OAK) received by patients across five European countries, and to obtain patients' perceptions and willingness to pay for current treatments. PATIENTS AND METHODS A prospective, internet-based, double-blind survey of adults with OAK was conducted in France, Germany, Italy, Spain, and the United Kingdom. The questionnaire included questions about diagnosis, treatment history, and perceptions of OAK treatments, followed by a discrete choice-based conjoint exercise to identify preferred attributes of OAK treatments, evaluating 14 sets of four unbranded products. RESULTS Two thousand and seventy-three patients with self-reported OAK completed the survey; 17.4% of patients rated their knee pain as drastically affecting their ability to perform normal daily activities, and 39.3% of employed patients reported that they had lost work time because of OAK. The most common treatments were exercise (69.7%), physical therapy (68.2%), and nonprescription oral pain medication (73.9%). Treatments perceived as most effective were: viscosupplement injections (74.1%), narcotics (67.8%), and steroid injection (67.6%). Patient co-pay, duration of pain relief, and type of therapy exhibited the largest impact on patient preference for OAK treatments. The average patient was willing to pay €35 and €64 more in co-pay for steroid and viscosupplement injections, respectively, over the cost of oral over-the-counter painkillers (per treatment course, per knee) (each P<0.05). CONCLUSION OAK is a debilitating condition that affects normal daily activities. In general, treatments most commonly offered to patients are not those perceived as being the most effective. Patients are willing to pay a premium for treatments that they perceive as being more effective and result in longer-lasting pain relief, and those that can be administered with fewer visits to a physician.
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Affiliation(s)
- John Posnett
- HERON™ Commercialization, PAREXEL® International, London, UK
| | | | | | | | - Nazanin Mehin
- Sanofi, Paris, France
- Correspondence: Nazanin Mehin, Sanofi, 9 Boulevard Romain Rolland, 75014, Paris, France, Tel +33 1 53 77 88 50, Email
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