Emmanuel Maheu1, Raveendhara R Bannuru2, Gabriel Herrero-Beaumont3, Fadoua Allali4, Hervé Bard5, Alberto Migliore6. 1. Rheumatology Department, AP-HP, Saint-Antoine Hospital, 4 Blvd. Beaumarchais, 75011 Paris, France. Electronic address: emaheu@wanadoo.fr. 2. Center for Treatment Comparison and Integrative Analysis, Tufts Medical Center, Boston, MA 02111, USA. 3. Rheumatology Service, Joint and Bone Research Unit, Autonomous University of Madrid, Fundación Jiménez Díaz, Madrid, Spain. 4. Department of Rheumatology, El Ayachi University-Hospital, Sale, Morocco. 5. American Hospital of Paris, French Healthcare System, 63 Boulevard Victor Hugo, 92200 Neuilly-sur-Seine, France. 6. Unit of Rheumatology, San Pietro Fatebenefratelli Hospital, Rome, Italy.
Abstract
OBJECTIVES: There is a discrepancy between evidence in support of the widespread use of intra-articular hyaluronic acid (IAHA) to treat knee osteoarthritis (OA) in clinical practice, and the often discordant recommendations from multiple international guideline committees, which requires further investigation. METHODS: We conducted a literature review to determine the strength of evidence in support of the efficacy and safety of IAHA, from randomized controlled trials and meta-analyses. RESULTS: Our analysis shows that IAHA provides a moderate symptomatic benefit to knee OA patients and without major safety concerns. In fact, IAHA may offer one of the best benefit/risk ratios among pharmacologic options, as measured by improvements in knee OA health outcomes, overall gain in quality-adjusted life years and substantial delays in time to total knee replacement. CONCLUSIONS: We advocate for the consideration of recommending IAHA injection as a treatment option in the management of knee OA, tailored by disease stage and patient phenotype. Future research efforts should focus on identification of OA patient subgroups that demonstrate a more robust response to IAHA, determination of long-term effects of repeat IAHA injections on patient-reported outcomes and total knee replacement-sparing effect, further elucidation of disease-modifying effects, and the potential for combination therapy with other pharmacologic and non-pharmacologic therapies to optimize the management of knee OA.
OBJECTIVES: There is a discrepancy between evidence in support of the widespread use of intra-articular hyaluronic acid (IAHA) to treat knee osteoarthritis (OA) in clinical practice, and the often discordant recommendations from multiple international guideline committees, which requires further investigation. METHODS: We conducted a literature review to determine the strength of evidence in support of the efficacy and safety of IAHA, from randomized controlled trials and meta-analyses. RESULTS: Our analysis shows that IAHA provides a moderate symptomatic benefit to knee OA patients and without major safety concerns. In fact, IAHA may offer one of the best benefit/risk ratios among pharmacologic options, as measured by improvements in knee OA health outcomes, overall gain in quality-adjusted life years and substantial delays in time to total knee replacement. CONCLUSIONS: We advocate for the consideration of recommending IAHA injection as a treatment option in the management of knee OA, tailored by disease stage and patient phenotype. Future research efforts should focus on identification of OA patient subgroups that demonstrate a more robust response to IAHA, determination of long-term effects of repeat IAHA injections on patient-reported outcomes and total knee replacement-sparing effect, further elucidation of disease-modifying effects, and the potential for combination therapy with other pharmacologic and non-pharmacologic therapies to optimize the management of knee OA.
Authors: Nicola Veronese; Cyrus Cooper; Jean-Yves Reginster; Marc Hochberg; Jaime Branco; Olivier Bruyère; Roland Chapurlat; Nasser Al-Daghri; Elaine Dennison; Gabriel Herrero-Beaumont; Jean-François Kaux; Emmanuel Maheu; René Rizzoli; Roland Roth; Lucio C Rovati; Daniel Uebelhart; Mila Vlaskovska; André Scheen Journal: Semin Arthritis Rheum Date: 2019-01-11 Impact factor: 5.532
Authors: Jun Xiao; Yong Hu; Lin Huang; Zhi-Fa Huang; Wei-Zhou Jiang; Yu-Qiang Luo; Meng-Yan Jia; Di Chen; Zhan-Jun Shi Journal: Drug Deliv Transl Res Date: 2021-02 Impact factor: 4.617