One-year follow-up of efficacy and cost of repeated doses versus single larger dose of intra-articular hyaluronic acid for knee osteoarthritis

Abstract

Purpose: A recent 3-month randomized, open-label controlled trial found that the intra-articular hyaluronic acid injection (GO-ON®) given as a single dose of 5 mL is as effective and safe as three repeated doses of 2.5 mL in patients with knee osteoarthritis. However, the information on the long-term efficacy and economic implications of the single-dose regimen is still limited. Hence, this follow-up study was designed to compare the effectiveness and costs of the two regimens 12 months following the treatment. Methods: All the 127 patients, who received either three repeated doses ( n = 64) or a single dose ( n = 63) of GO-ON in the previous trial, were followed up in month 12 following the treatment. The effectiveness of both the regimens was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the mean WOMAC scores were compared with those recorded at the baseline and in month 3. Additionally, the total treatment costs of the two regimens, taking account of both direct and indirect costs, were computed and compared. Results: A total of 125 patients (98.4%) completed the assessment. Despite the reduction of the overall mean WOMAC score from 39.24 to 19.93 ( p < 0.001) in the first 3 months following the treatment with GO-ON, no further changes were observed up to month 12 ( p > 0.95). In the meantime, the two regimens did not differ in the mean WOMAC scores ( p = 0.749) and in the subscale scores for pain ( p = 0.970), stiffness ( p = 0.526), and physical functioning ( p = 0.667) in month 12. The cost for single-dose injection was found to be approximately 30% lower compared to the repeated doses. Conclusion: These findings indicate that the single larger dose of GO-ON is as effective as the repeated doses over 12 months, and yet the total treatment cost is lowered.

Comparative matched-pair cohort analysis of the short-term clinical outcomes of mesenchymal stem cells versus hyaluronic acid treatments through intra-articular injections for knee osteoarthritis

“…We speculate that the short-term clinical outcomes were mainly affected by the enhancement of the microenvironment, immune-regulation and anti-inflammatory effects rather than cartilage regeneration itself, because cartilage regeneration would probably require a longer time to occur or would not happen even at longer follow up after MSC injections as described in several previous studies [18,33]. The efficacy of HA injections on pain relief and joint function restoration has been evaluated in numerous studies [10,19,26,40,41,51], and recent systematic reviews have shown that improvements in pain intensity and functional outcomes were likely to take effect in 4-8 weeks and could last up to 6 months [3,47]. Moreover, Suppan et al [51] suggested that HA efficacy was sustainable for ≥1 year.…”

“…Third, the optimal number of MSCs and dosage of HA remain unknown. Presently, low (0.5 × 10 6 –1 × 10 6 Da), intermediate (2 × 10 6 Da), or high (6 × 10 6 Da) molecular weights (MW) of HA are marketed; it is recommended to administer the low and intermediate MW of HA weekly for three to five doses, and the high MW of HA as a single larger dose [51]. In this study, high MW of HA was used.…”

Thermosensitive In Situ Gels for Joint Disorders: Pharmaceutical Considerations in Intra-Articular Delivery

“…Since 2004, a single-injection IA HA therapy (3 mL, 60 mg) has been suggested as an alternative to the multi-injection regimen (currently 3 × 2 mL, 20 mg per injection), dispensing the same quantity of HA. A single injection would reduce the number of medical visits, intrusive procedures, and other associated risks [ 32 ]. HA increases the viscosity and elasticity of synovial fluid.…”

Injectable therapies for knee osteoarthritis

“…A more recent RCT by Suppan et al [ 44 ] compared single dose vs. repeated doses of HA injections and found that there was no significant difference between groups for pain scores up to 12 months. These results were corroborated by a recent 2019 meta-analysis of 28 studies, which concluded that single HA injections produced results comparable to those of multiple injections [ 45 ].…”

“…These results were corroborated by a recent 2019 meta-analysis of 28 studies, which concluded that single HA injections produced results comparable to those of multiple injections [ 45 ]. Because there is an approximately 30% lower cost associated with single-dose vs. multiple-dose regimes of HA, a single larger dose of HA is suggested as a future point of exploration [ 44 ].…”