Differences regarding Branded HA in Italy, Part 2: Data from Clinical Studies on Knee, Hip, Shoulder, Ankle, Temporomandibular Joint, Vertebral Facets, and Carpometacarpal Joint

Abstract

OBJECTIVESThe aim of the current study is to collect scientific data on all branded hyaluronic acid (HA) products in Italy that are in use for intra-articular (IA) injection in osteoarthritis (OA) compared with that reported in the leaflet.METHODSAn extensive literature research was performed for all articles reporting data on the IA use of HA in OA. Selected studies were taken into consideration only if they are related to products based on HAs that are currently marketed in Italy with the specific joint indication for IA use in patients affected by OA.RESULTSSixty-two HA products are marketed in Italy: 30 products are indicated for the knee but only 8 were proved with some efficacy; 9 products were effective for the hip but only 6 had hip indication; 7 products proved to be effective for the shoulder but only 3 had the indication; 5 products proved effective for the ankle but only one had the indication; 6 products were effective for the temporomandibular joint but only 2 had the indication; only 2 proved effective for vertebral facet joints but only 1 had the indication; and 5 products proved effective for the carpometacarpal joint but only 2 had the indication.CONCLUSIONSThere are only a few products with some evidences, while the majority of products remain without proof. Clinicians and regulators should request postmarketing studies from pharmaceuticals to corroborate with that reported in the leaflet and to gather more data, allowing the clinicians to choose the adequate product for the patient.

Short-Term Effects of Intra-Articular Hyaluronic Acid Administration in Patients with Temporomandibular Joint Disorders

“…In an analysis of 7 publications by the authors listed below, the relationship between the initial value of mandibular excitation and its increase in the course of therapy was also observed for joint cavity rinsing. It may be presented by the following formula: y = −0.4 × x + 23.0 mm (2) where x is the initial amplitude of mandibular opening, and y is an increase in the amplitude of the opening following joint lavage. In the discussed material, the final amplitudes of mandibular opening after joint cavity rinsing were, on average, as much as 5 mm higher than the expected results of treatment of the same group of patients who were treated only with intra-articular HA injections.…”

“…Viscosupplementation, i.e., supplementation with a component of synovial fluid in the form of intra-articular injections, is one of the possible solutions to reduced HA levels in joint cavities in chronic inflammation, already successfully used in the treatment of knee osteoarthritis [1]. Importantly, a detailed summary of 24 reports on 6 HA-based preparations used in the viscosupplementation of temporomandibular joints showed no serious adverse events [2].…”

Effectiveness and Tolerability of Repeated Courses of Viscosupplementation in Symptomatic Hip Osteoarthritis: A Retrospective Observational Cohort Study of High Molecular Weight vs. Medium Molecular Weight Hyaluronic Acid vs. No Viscosupplementation

“…The hip is a difficult joint to inject, and many studies in the literature show greater safety and precision when the procedure is guided by ultrasound (US) (Migliore et al, 2003; Migliore et al, 2006b). Usually, many HAs with different characteristics are used (Migliore et al, 2016), but a clear priority is given to high molecular weight (MW) HA (Tikiz et al, 2005; van den Bekerom et al, 2008). Whether MW differences are associated with different therapeutic effects or durability, it is still to be clarified.…”