A Review of the Clinical Effectiveness and Safety of Hybrid Cooperative Complexes in Intra-articular Viscosupplementation

Abstract

Viscosupplementation by intra-articular (i.a.) injection of the non-sulfated glycosaminoglycan (GAG) hyaluronic acid (HA) is a conservative therapy widely accepted in clinical practice for the management of osteoarthritis (OA) and joint diseases. The aim of viscosupplementation is to restore the rheological properties of the synovial fluid to relieve joint inflammation and pain and improve joint function through a chondroprotective effect. However, there is a range of hyaluronic acid products for OA that differ in preparation, molecular weight, rheological characteristics and concentration, and different i.a. formulations are more suited to particular patient populations and clinical situations, in part because of anatomical differences between joints. This paper focuses on innovative hybrid cooperative complexes of high and low molecular weight hyaluronic acid (HA-HL) and hyaluronic acid plus sodium chondroitin (HA-SC) that have been developed. Both products are formulated with pharmaceutical-grade, highly purified hyaluronic acid obtained with a multi-step biofermentation process, with properties that make them suitable across a range of degenerative joint diseases. They represent progress in building on the symptomatic and functional benefits of viscosupplementation in joint disease, with the additional beneficial effect of treating the patient with a high concentration of GAGs by a low number of injections. Here, we review the clinical evidence for the efficacy of a hybrid cooperative compound of HA-HL in various degenerative joint diseases, which suggests a synergistic effect of the different molecular weight hyaluronans that together more closely mimic the physiological composition of synovial fluid. Similarly, the evidence shows that HA-SC is safe, effective, and well tolerated in hip OA, with rapid and clinically significant improvements in pain symptoms and functionality. Such innovations in viscosupplementation expand the usefulness of the modality in the management of OA and other joint diseases, complemented by a lack of systemic or local side effects that allow the concurrent use of other drugs if needed.

Safety of Epidural Hyaluronic Acid Injections in Managing the Symptoms of Lumbar Foraminal Stenosis: A Prospective Preliminary Study

“…If proper spreading was achieved, the volume of 2 mL of HA (Sinovial HL, IBSA) was slowly injected with the constant observation of active ipsilateral foot movement. The Sinovial HL product was chosen because of its small volume of injectate; it has also been registered for extra-articular administration (tendons and ligaments) [ 18 ]. Each patient was observed 30 min after injection and the exercise program was launched the following day.…”

Local injection therapy with hyaluronic acid preparations: in focus of rheumatologists and orthopedic traumatologists

“…НМ ГлК -более текучая и менее стойкая субстанция, которая, однако, характеризуется быстрым биологическим эффектом, связанным с антиноцицептивным, противовоспалительным и анаболическим действием. Учитывая различия в механизме действия ВМ и НМ ГлК, возникла идея совместить их преимущества в комбинированном препарате [43]. Эта идея была реализована в виде нового фармацевтического продукта -Картигиал Кросс 1 .…”