NASHA hyaluronic acid vs methylprednisolone for knee osteoarthritis: a prospective, multi-centre, randomized, non-inferiority trial

Leighton, Ross; Åkermark, Christian; Therrien, Roxane; Richardson, JB; Andersson, Matilda; Todman, Martin G.; Arden, N K

doi:10.1016/j.joca.2013.10.009

Cited by 88 publications

(101 citation statements)

References 26 publications

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“…Our results are consistent with studies of intra-articular NASHA injection for knee and hip OA,14–18 showing a long duration of action and favorable tolerability. For example, a 26-week study comparing single-injection NASHA with methylprednisolone acetate in knee OA showed similar Western Ontario and McMaster Universities (WOMAC) OA pain index responder rates in the two study groups at 12 weeks, with the WOMAC pain effect size increasingly favoring NASHA between 12 and 26 weeks 18.…”

Section: Discussionsupporting

confidence: 91%

Single-arm open-label study of Durolane (NASHA nonanimal hyaluronic acid) for the treatment of osteoarthritis of the thumb

Velasco

Ribera

Pi³

2017

OARRR

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IntroductionOsteoarthritis of the trapeziometacarpal (TMC) joint of the thumb – also known as rhizarthrosis – is painful and has a significant impact on quality of life. Intra-articular injection of hyaluronic acid may potentially meet the need for effective, minimally invasive intervention in patients not responding adequately to initial treatment. We aimed to confirm the safety and effectiveness of viscosupplementation with Durolane (NASHA nonanimal hyaluronic acid) in rhizarthrosis.Patients and methodsThis was a prospective, single-arm, multicenter, open-label study with a 6-month follow-up period. Eligible patients had Eaton–Littler grade II–III rhizarthrosis in one TMC joint with pain and visual analog scale (VAS) pain score ≥4 (scale: 0–10). A single injection of NASHA was administered to the affected TMC joint. The primary effectiveness variable was change from baseline in VAS pain score.ResultsThirty-five patients (mean age 60.8 years; 85.7% female) received NASHA and completed the study. The least-squares mean change from baseline in VAS pain score over 6 months was −2.00, a reduction of 27.8% (p<0.001). The reduction in pain exceeded 25% as early as month 1 (26.5%), and gradual improvement was observed throughout the 6-month follow-up period. Secondary effectiveness parameters included QuickDASH (shortened version of Disabilities of the Arm, Shoulder, and Hand [DASH]), Kapandji thumb opposition test, radial abduction, metacarpophalangeal (MCP) joint flexion, and pinch (clamp) strength. Most of these measurements showed statistically significant improvements from baseline over 6 months. Five adverse events (injection site reactions) were reported in four patients (11.4%), and there were no serious or allergic reactions.ConclusionThis study suggests that viscosupplementation using NASHA is effective and well tolerated in treating the symptoms of rhizarthrosis.

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Section: Discussionsupporting

confidence: 91%

Single-arm open-label study of Durolane (NASHA nonanimal hyaluronic acid) for the treatment of osteoarthritis of the thumb

Velasco

Ribera

Pi³

2017

OARRR

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“…In general, while CSs have shown to be more effective (especially on pain control) in the short term (<1 month), better results have been reported with HA at subsequent evaluations, providing only a moderate effect after 26 weeks (8,12,17,(33)(34)(35)(36)(37)(38)(39). Furthermore, the efficacy of repeated injections of HA, after a previous course of either HA or CSs, has also been proved (37,40). However, other studies neglected the efficacy of HA (41-44), reporting only small or no differences compared with CSs.…”

Section: Rationale: Css Vs Hamentioning

confidence: 99%

“…Furthermore, HA is considered safe also after a previous course of HA injections (35,37,40). Despite this evidence, the safety profile of intra-articular HA injections has recently been questioned (43).…”

Section: Adverse Events and Safetymentioning

confidence: 99%

Hyaluronic acid vs corticosteroids in symptomatic knee osteoarthritis: a mini-review of the literature

Bisicchia

Tudisco

2017

ccmbm

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SummaryIntroduction. Although intra-articular injections of hyaluronic acid (HA) are common non-operative measures used in clinical practice in the management of symptomatic osteoarthritis, there is a great controversy on their efficacy and safety compared to corticosteroids (CSs). Efficacy. Conflicting results have been reported in clinical trials and meta-analysis due to methodological differences in study design, along with collection, analysis, and interpretation of data. Even if some studies reported small or no differences of HA compared with CSs (or inferred that HA is not more effective than saline as a placebo), in general CSs have shown to be superior in the short term (especially on pain control), while better results have been reported with HA at subsequent evaluations, but with only a moderate effect after 26 weeks. Safety. Mild or moderate adverse events have generally been reported after HA injections, the most common being injection site pain. HA is generally considered safe compared to CSs or saline. Furthermore, HA has shown to be safe also after a previous course of injections. Conclusions. Conflicting results have been reported on the efficacy and safety of HA. Guidelines are controversial and in most of the cases "uncertain" recommendations are provided due to inconclusive evidence in literature. However, HA does not seem to have significantly higher side effects when compared to saline or CSs injections, and provides better medium-term control of symptoms in patients with mild to moderate knee osteoarthritis.

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“…[25], в котором оценивалась эффективность однократной в/с инъекции высокомолекулярной синтети-ческой гиалуроновой кислоты и ГК (метилпреднизолон) у 442 больных ОА коленного сустава. Через 12 нед число от-ветивших на лечение по WOMAC-боль (уменьшение на >40%) в исследуемых группах не различалось (44,6 и 46,2% соответственно, т. е.…”

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Dissatisfaction with management of musculoskeletal pain: A global problem and methods of its solution

Каратеев¹

2017

RJTAO

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Идеальная стратегия терапии любого заболевания предполагает этиотропный и патогенетический подход. Всегда следует искать причину болезни (например, если ее развитие вызвано инфекционным агентом), а когда это не-возможно (как в подавляющем большинстве случаев при хронических заболеваниях), четко выделить основные зве-нья ее патогенеза. Точное знание направления фармакоте-рапии ориентирует на очень высокий результат, которого можно достичь в процессе лечения: полное прекращение прогрессирования болезни, т. е. стойкая медикаментозная, а при благоприятном стечении обстоятельств и безмедика-ментозная ремиссия или даже полное выздоровление. (non-steroidal anti-inflammatory drugs (NSAIDs), opioids, local glucocorticoid injections, duloxetine, etc.) Effective control of musculoskeletal pain (MSP) is one of the main tasks of medical care for the most common rheumatic diseases, such as osteoarthritis (OA) and non-specific back pain (NSBP). Epidemiological surveys have shown that a substantial proportion (about 40-50%) of patients consider their assigned treatment to be ineffective and are dissatisfied with its results. The reasons for this are a phenotypic diversity of MSP, individual responses to analgesic drugs, and comorbidities (particularly metabolic disorders and depression). Placebo-controlled trials have demonstrated that monotherapy with the most popular drugs

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NASHA hyaluronic acid vs methylprednisolone for knee osteoarthritis: a prospective, multi-centre, randomized, non-inferiority trial

Cited by 88 publications

References 26 publications

Single-arm open-label study of Durolane (NASHA nonanimal hyaluronic acid) for the treatment of osteoarthritis of the thumb

Single-arm open-label study of Durolane (NASHA nonanimal hyaluronic acid) for the treatment of osteoarthritis of the thumb

Hyaluronic acid vs corticosteroids in symptomatic knee osteoarthritis: a mini-review of the literature

Dissatisfaction with management of musculoskeletal pain: A global problem and methods of its solution

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