R Leighton1, C Akermark2, R Therrien3, J B Richardson4, M Andersson5, M G Todman6, N K Arden7. 1. QEII Health Sciences Centre, New Halifax Infirmary, Halifax, NS, Canada. Electronic address: r.k.leighton@ns.sympatico.ca. 2. Sport Med, Birger Jarlsgatan 106A, SE-11420 Stockholm, Sweden. 3. Centre de Rhumatologie St-Louis, Saint-Foy, Quebec, Canada G1W4R4. 4. Robert Jones and Agnes Hunt Orthopaedic & District Hospital, Institute of Orthopaedics Oswestry, SY10 7AG, UK. 5. Q-Med AB, Seminariegatan 21, 752 28 Uppsala, Sweden. 6. Smith & Nephew UK Ltd, Research Centre, York Science Park, York, UK. 7. NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, UK.
Abstract
OBJECTIVE: To compare NASHA hyaluronic acid gel as single-injection intra-articular (IA) treatment for knee osteoarthritis (OA) against methylprednisolone acetate (MPA). DESIGN: This was a prospective, multi-centre, randomized, active-controlled, double-blind, non-inferiority clinical trial. A unique, open-label extension phase (OLE) was undertaken to answer further important clinical questions. Subjects with painful unilateral knee OA were treated and followed for 26 weeks (blinded phase). All patients attending the clinic at 26 weeks were offeredNASHA treatment, with a subsequent 26-week follow-up period (extension phase). The primary objective was to show non-inferiority of NASHA vs MPA in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain responder rate (percentage of patients with ≥40% improvement from baseline in WOMAC pain score and an absolute improvement of ≥5 points) at 12 weeks. RESULTS: In total, 442 participants were enrolled. The primary objective was met, with NASHA producing a non-inferior response rate vs MPA at 12 weeks (NASHA: 44.6%; MPA: 46.2%; difference [95% CI]: 1.6% [-11.2%; +7.9%]). Effect size for WOMAC pain, physical function and stiffness scores favoured NASHA over MPA from 12 to 26 weeks. In response to NASHA treatment at 26 weeks, sustained improvements were seen in WOMAC outcomes irrespective of initial treatment. No serious device-related adverse events (AEs) were reported. CONCLUSIONS: This study shows that single-injection NASHA was well tolerated and non-inferior to MPA at 12 weeks. The benefit of NASHA was maintained to 26 weeks while that of MPA declined. An injection of NASHA at 26 weeks conferred long-term improvements without increased sensitivity or risk of complications. STUDY IDENTIFIER: NCT01209364 (www.clinicaltrials.gov).
RCT Entities:
OBJECTIVE: To compare NASHA hyaluronic acid gel as single-injection intra-articular (IA) treatment for knee osteoarthritis (OA) against methylprednisolone acetate (MPA). DESIGN: This was a prospective, multi-centre, randomized, active-controlled, double-blind, non-inferiority clinical trial. A unique, open-label extension phase (OLE) was undertaken to answer further important clinical questions. Subjects with painful unilateral knee OA were treated and followed for 26 weeks (blinded phase). All patients attending the clinic at 26 weeks were offered NASHA treatment, with a subsequent 26-week follow-up period (extension phase). The primary objective was to show non-inferiority of NASHA vs MPA in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain responder rate (percentage of patients with ≥40% improvement from baseline in WOMAC pain score and an absolute improvement of ≥5 points) at 12 weeks. RESULTS: In total, 442 participants were enrolled. The primary objective was met, with NASHA producing a non-inferior response rate vs MPA at 12 weeks (NASHA: 44.6%; MPA: 46.2%; difference [95% CI]: 1.6% [-11.2%; +7.9%]). Effect size for WOMAC pain, physical function and stiffness scores favoured NASHA over MPA from 12 to 26 weeks. In response to NASHA treatment at 26 weeks, sustained improvements were seen in WOMAC outcomes irrespective of initial treatment. No serious device-related adverse events (AEs) were reported. CONCLUSIONS: This study shows that single-injection NASHA was well tolerated and non-inferior to MPA at 12 weeks. The benefit of NASHA was maintained to 26 weeks while that of MPA declined. An injection of NASHA at 26 weeks conferred long-term improvements without increased sensitivity or risk of complications. STUDY IDENTIFIER: NCT01209364 (www.clinicaltrials.gov).
Authors: Yves-Marie Pers; Lars Rackwitz; Rosanna Ferreira; Oliver Pullig; Christophe Delfour; Frank Barry; Luc Sensebe; Louis Casteilla; Sandrine Fleury; Philippe Bourin; Danièle Noël; François Canovas; Catherine Cyteval; Gina Lisignoli; Joachim Schrauth; Daniel Haddad; Sophie Domergue; Ulrich Noeth; Christian Jorgensen Journal: Stem Cells Transl Med Date: 2016-05-23 Impact factor: 6.940
Authors: Heng Zhang; Ke Zhang; Xianlong Zhang; Zhenan Zhu; Shigui Yan; Tiansheng Sun; Ai Guo; John Jones; R Grant Steen; Bin Shan; Jenny Zhang; Jianhao Lin Journal: Arthritis Res Ther Date: 2015-03-10 Impact factor: 5.156