Effects of Hylan G-F 20 supplementation on cartilage preservation detected by magnetic resonance imaging in osteoarthritis of the knee: a two-year single-blind clinical trial

Abstract

BackgroundAlthough viscosupplementation is an effective symptomatic treatment for knee osteoarthritis (OA), the effect of longer term administration on articular cartilage has not been fully explored. We examined the effect of viscosupplementation with Hylan G-F 20 on knee cartilage over 2 years in patients with knee OA.MethodsIn this prospective, single-blind, parallel control group pilot study, 78 patients with symptomatic knee OA (Kellgren-Lawrence grade II and III) were assigned to either intervention group (n = 39 receiving 4 courses of 3 × 2.0 ml of intra-articular Hylan G-F 20 injections at 6 month intervals) or control group (n = 39 receiving usual care for knee OA without injections). Magnetic resonance imaging of the study knee was performed at baseline, 12 and 24 months. Cartilage volume and defects were assessed using validated methods.ResultsFifty-five subjects (71%) completed 24 month follow up. Over 24 months, the intervention group had a reduced annual percentage rate of medial and lateral tibial cartilage volume loss (mean ± SD, -0.3 ± 2.7% and -1.4 ± 4.3%) compared with the control group (2.3 ± 2.6% and 1.4 ± 2.6%, P = 0.001 and 0.005 for difference, respectively). The intervention group also showed reduced cartilage defect score increment in the medial tibiofemoral compartment (0.1 ± 1.3) compared with the control group (0.8 ± 1.5, P = 0.05).ConclusionsSix monthly intra-articular injections of Hylan G-F 20 administered to patients with symptomatic knee OA have a beneficial effect on knee cartilage preservation measured by both cartilage volume and cartilage defects. Hylan G-F 20 warrants further evaluation in larger clinical trials as a possible disease-modifying agent in the treatment of knee OA.Trial RegistrationThe study was registered with ClinicalTrials.gov (NCT00393393).

Efficacy and safety of hylan G-F 20 injection in treatment of knee osteoarthritis in Chinese patients: results of a prospective, multicentre, longitudinal study

“…In a magnetic resonance imaging-based RCT on articular cartilage volume change after four courses of hylan G-F 20 injection at 6-month intervals, the authors claimed that there was less cartilage loss in the treatment group at 24 months (2.7% over the medial tibial plateau and 2.6% over the lateral tibial plateau). 20 Whether these differences are clinically significant is doubtful, however. We could not find any specific factors predicting good clinical response in our patients.…”

Adding Triamcinolone Improves Viscosupplementation: A Randomized Clinical Trial

“…high-weight molecules contribute to form a high-viscosity solution, which serves as a lubricant and shock absorber [2,25], among other functions. Viscosupplementation reportedly relieves pain [13] but it also is considered a disease-modifying OA drug [14,29] with benefits that have been observed in a period of 6 months to 2 years [22]. It is believed that the long-term effectiveness of HA is attributable to its modulating action in the inflammatory process that occurs in the osteoarthritic joint and in its interaction with the CD44 synoviocytes receptors [28,30].…”

“…Clinical trials [8,29] and meta-analyses [3,7,11] have documented improvement in pain and function with viscosupplementation. Several placebo-controlled studies [4,7,11] showed an improvement began only within 2 to 5 weeks after the procedures.…”

Use of hyaluronic acid preparations in the combination therapy of osteoarthritis

“…Так, Y. Wang и соавт. [35] наблю-дали 78 больных ОА коленных суставов: 39 из них получили 4 курса по 3 инъекции гилана G-F 20, 39 больных контроль-ной группы -стандартную терапию. Магнитно-резонансная томография коленных суставов выполнялась исходно, через 12 и 24 мес.…”