High molecular weight Intraarticular hyaluronic acid for the treatment of knee osteoarthritis: a network meta-analysis

BMC Musculoskeletal Disorders

Lionel Duarte¹  Sophie S. Yoon¹  Colleen Manitt²  Emil Schemitsch³  Charles D. Hummer⁴  Felix Angst⁵  Wilson Ngai⁶  Craig Whittington⁷ 

[1] Doctor Evidence, Santa Monica, CA, USA;International Centre for Professional Development in Health and Medicine, Québec, Canada;London Health Sciences Centre, London, Ontario, Canada;Premier Orthopaedics and Sports Medicine, 300 Evergreen Drive, Suite 200, 19342, Glen Mills, PA, USA;Research Department, Rehabilitation Clinic (‘RehaClinic’), Bad Zurzach, Switzerland;Sanofi, Global Medical, Bridgewater, NJ, USA;Sanofi, Global Medical, Bridgewater, NJ, USA;Doctor Evidence, Santa Monica, CA, USA;

关键词: Hyaluronic acid;    Knee osteoarthritis;    Molecular weight;    Meta-analysis;   

DOI  :  10.1186/s12891-020-03729-w

来源: Springer

【 摘 要 】

BackgroundThe 2013 American Academy of Orthopaedic Surgeons (AAOS) guidelines made strong recommendations against intraarticular hyaluronic acid (IAHA) for patients with knee osteoarthritis (OA), as evidence supporting improvements in pain did not meet the minimal clinically important improvement (MCII) threshold. However, there may be important distinctions based on IAHA molecular weight (MW). Hence our objective was to evaluate the efficacy of IAHAs in knee OA based on molecular weight.MethodsRandomized controlled trials were searched within MEDLINE, Embase, and CENTRAL and selected based on AAOS criteria. A pain measure hierarchy and longest follow-up were used to select one effect size from each trial. Mean differences between interventions were converted to standardized mean differences (SMDs) and incorporated into a random-effects Bayesian network meta-analysis. High MW (HMW) was defined as ≥6000 kDa, and low MW (LMW) as < 750 kDa.ResultsHMW IAHA was associated with a statistically significant and possibly clinically significant improvement in pain (SMD − 0.57 (95% credible interval [Crl]: − 1.04, − 0.11), exceeding the − 0.50 MCII threshold. LMW IAHA had a lesser, non-significant improvement (− 0.23, 95% Crl: − 0.67, 0.20). Back-transforming SMDs to the WOMAC pain scale indicated a 14.65 (95% CI: 13.93, 15.62) point improvement over IA placebo, substantially better than the 8.3 AAOS MCII threshold.ConclusionsUnlike LMW IAHA, HMW IAHA exceeded the MCII threshold for pain relief, suggesting that improvements can be subjectively perceived by the treated patient. Amalgamation of LMW and HMW may have blurred the benefits of IAHA in the past, leading to negative recommendations. Differentiation according to MW offers refined insight for treatment with IAHA.

【 授权许可】

CC BY