Comparison of three treatment protocols with intra-articular low or intermediate molecular weight hyaluronic acid in early symptomatic knee osteoarthritis

Abstract

Introduction: Viscosupplementation with hyaluronic acid (HA) is indicated for non-responders to non-pharmacological therapy, to analgesics or when non-steroidal anti-inflammatory drugs (NSAIDs) are contraindicated. The aim of this study is to compare the efficacy, safety and costs of three different HA treatments ( Sinovial® Forte, sinovial one and hyalgan). Patients and methods: Ninety patients with grade I/II Kellgren–Lawrence knee osteoarthritis were included in three groups, the first was treated with hyalgan (weekly for 5 weeks), the second with Sinovial® Forte (weekly for 3 weeks) and the third group with a single injection of sinovial one. Results: All three treatments were effective, with an average reduction in the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) score of 18.9 points for hyalgan, 18.04 points for Sinovial® Forte and 17.92 points for sinovial one. The comparison of the three groups did not show any statistical difference in terms of efficacy. National health system (NHS) and social costs are, respectively, €419.12 and €853.43 for hyalgan, €338.64 and €599.22 for Sinovial® Forte, €221.56 and €308.42 for sinovial one. Conclusion: All three treatments were equally effective with no statistically significant differences; thus, the treatment with sinovial one may be considered as clinically effective as the other two regimens, but with a very efficient cost profile in early symptomatic knee osteoarthritis.

Health Economic Evaluation of a High and Low Molecular Weight Hyaluronic Acid Formulation for the Treatment of Knee Osteoarthritis. Post Hoc Analyses from a Randomized Clinical Trial

“…In addition, few studies have compared the cost or the cost-effectiveness of different HA products. Recently, the authors of a real-life retrospective observational study that compared three different formulations of HA with different treatment modalities (weekly for 5 weeks, weekly for 3 weeks or a single injection) came to the conclusion that all three treatments were equally effective [ 15 ]. However, the one that had one single injection had the best cost profile, from both a National Italian Health System and a social cost point of view.…”

The Booster Effect of a Single Quarterly Dose of Hyaluronic Acid in Knee Osteoarthritis: Five-Year Results of a Registry-Based Study

“…), especially in elderly patients, and in those with comorbidities. Furthermore, previous studies had already demonstrated the non-superiority of single-dose treatments compared to the three-weekly standard protocol of HA viscosupplementation [9].…”

“…Unfortunately, there are no curative treatments but only symptomatic, with prosthetic replacement in the most advanced cases, which is a significant cost to health systems [3]. Treatment includes nonsteroidal anti-inflammatory drugs (systemic and topical), acetaminophen, disease-modifying OA drugs, and symptomatic slow-acting drugs for osteoarthritis [4][5][6][7], intra-articular injection of corticosteroids, hyaluronic acid [8][9], or platelet-rich plasma [10], botulinum toxin [11][12], genicular nerve block [13], cooled or traditional radiofrequency ablation [14] and genicular artery embolization [15].…”

“…The treatment schedules are also very variable, from weekly injections for three or five weeks every six months, to single doses, to those with a booster after 15 days or one month, and so on. To date, in fact, in the literature, there is no univocal therapeutic protocol for treatment with hyaluronic acids, and therefore the choice is often left to the experience of the doctor or to the clinical response of the patient [9].…”

Efficacité à un an des injections synchrones de plasma riche en plaquettes et acide hyaluronique dans la gonarthrose

“…En revanche, il existe des différences de poids moléculaires et de structure (Figure 3). Dans le peu d'étude face/face comparant des AH, il n'a pas pu être démontrer de différence d'efficacité (24). L'autre différence importante concerne la structure de l'acide hyaluronique.…”