Pilot Study to Evaluate the Efficacy of Polynucleotide Sodium Compared to Sodium Hyaluronate and Crosslinked Sodium Hyaluronate in Patients with Knee Osteoarthritis

Abstract

Degenerative arthritis of the knee joint has become a major social problem worldwide due to population aging. There are several treatment options for knee osteoarthritis, and the intraarticular injection of sodium hyaluronate is commonly selected by many clinicians as a nonsurgical treatment. However, the efficacy of the treatment is controversial. In this pilot study, we aimed to compare polynucleotide sodium (Conjuran®) with sodium hyaluronate (Hyruan Plus®) and 1,4-butanediol diglycidyl ether-crosslinked sodium hyaluronate (Synovian®) in terms of analgesic efficacy after intraarticular injection in patients with knee osteoarthritis. One of the three intraarticular agents was selected according to what agents were available for outpatients when each patient was enrolled in the study. The 15 enrolled patients were subdivided into 3 groups of 5 patients each. Three injections were performed under ultrasound guidance at a 1-week intervals over a total of 3 weeks. The visual analog scale (VAS) score, the Korean version of the Western Ontario and McMaster Universities Arthritis Index (K-WOMAC), the EuroQol five-dimension scale (EQ-5D) score, and the Korean version of the painDETECT Questionnaire (K-PDQ) score were evaluated before injection and at 1, 2, and 6 weeks after the start of the treatment protocol. The primary endpoint was the change in weight-bearing pain at 4 weeks after the last injection. Secondary endpoints included pain at rest and during walking and the K-WOMAC, EQ-5D, and K-PDQ scores. Weight-bearing pain decreased significantly more from pretreatment to 6 weeks after the start of the treatment protocol in the polynucleotide sodium-treated patients than in the patients who were treated with other agents (p = 0.006, one-way ANOVA). There were no significant between-group differences in the other secondary endpoints. No adverse events occurred. In conclusion, polynucleotide sodium could effectively reduce weight-bearing pain in the patients with knee osteoarthritis compared to standard hyaluronic acid viscosupplementation.

Viscosupplementation in the Therapy for Osteoarthritic Knee

“…It has been reported that PN can be used in a 40 mg/2 mL prefilled syringe and PDRN can be used at 5.625 mg/3 mL (Placentex Inj ® ; Mastelli srl, Sanremo, Italy) [116,122]. The number of uses of PN or PDRN can be once a week to about 3-5 times, like HA [119,124,128]. PDRN/PN has recently been used in knee osteoarthritis compared to HA or CL HA.…”

Recent Developments in Hyaluronic Acid-Based Hydrogels for Cartilage Tissue Engineering Applications

“…The performance of Cartistem ® was also compared with microfracture, a method applied successfully for the repair of small cartilage defects and not so successfully for the repair of large cartilage lesions [ 105 ] ( Table 3 ). Apart from Cartistem ® , a limited number of acellular HA-based hydrogels (e.g., Hydros, Hydros-TA [ 106 ], Gel-One ® [ 107 , 108 , 109 , 110 ], HYA-JOINT Plus [ 111 ], hylastan SGL-80 [ 112 ], Cingal ® [ 113 ], Monovisc ® [ 113 , 114 ], Durolane ® [ 115 , 116 , 117 ], XLHA [ 118 ] and Synovian ® [ 119 ]) have also been evaluated in clinical trials regarding their (long-lasting) analgesic efficiency and improvement of physical function in comparison with typical HA-based viscosupplements and corticosteroids in patients with knee OA ( Table 3 ).…”

Effects of a Combination of Polynucleotide and Hyaluronic Acid for Treating Osteoarthritis

“…In this context, Condrotide (20 mg/mL, Mastellisa, Italy), an innovative medical product composed of polynucleotides (PN), has been developed and utilized since 2010 [33][34][35][36][37]. PNs, derived from the milt of salmon or trout, consist of (deoxy)ribonucleotides containing purines and pyrimidines.…”