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Efficacy and Safety of Hylan versus Hyaluronic Acid in the Treatment of Knee Osteoarthritis.
J Knee Surg. 2019 Mar; 32(3):259-268.JK

Abstract

The purpose of this study was to use meta-analytic approach to compare the efficacy and safety of intraarticular hylan and hyaluronic acid (HA) for knee osteoarthritis (OA) treatment. We searched PubMed, Embase, and the Cochrane databases through July 2017 to identify Level I randomized controlled trials (RCTs) that evaluated clinical efficacy and safety of hylan compared with HA for knee OA. The primary outcomes were Visual Analogue Scale (VAS) for pain and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, and WOMAC function scores. In each study and for the outcome measures (VAS for pain, WOMAC pain, function and stiffness scores, and Lequesne score), we calculated the treatment effect from the difference between the preintervention and postintervention changes in the hylan and HA groups. Twenty-one RCTs involving 3,058 patients were included. Pooled analysis suggested that compared with HA, hylan was associated with similar pain relief and function improvement in patients with knee OA (VAS for pain: mean difference [MD], -3.04; 95% confidence interval [CI], -9.13 to 3.04; p = 0.33; I 2 = 76%. WOMAC pain score: MD, 0.23; 95% CI, -0.25 to 0.70; p = 0.35; I 2 = 0%. WOMAC function score: MD, -0.47; 95% CI, -6.81 to 5.88; p = 0.88; I 2 = 84%). No significant difference was found comparing the patients with treatment-related adverse events. The relationship was robust in sensitivity analysis and consistent in most of the subgroup analyses. As to the primary outcomes (WOMAC pain, function scores, VAS for pain), the difference between hylan and HA did not reach the previously reported minimum clinically important difference (MCID) values (-13.4 for VAS for pain, -2.0 for WOMAC pain score, -7.7 for WOMAC function score). Our meta-analysis showed that there were no statistically and clinically significant differences in pain relief and function improvement between hylan and HA injections for knee OA treatment. In view of its higher costs, we discourage the use of hylan in patients with knee OA in clinical practice. The level of evidence is I, meta-analysis of Level I studies.

Authors+Show Affiliations

Department of Orthopedic Surgery, Southern Medical University, Nanfang Hospital, Guangzhou, China.Department of Orthopedic Surgery, Southern Medical University, Nanfang Hospital, Guangzhou, China.Department of Orthopedic Surgery, Southern Medical University, Nanfang Hospital, Guangzhou, China.Department of Orthopedic Surgery, Southern Medical University, Nanfang Hospital, Guangzhou, China.Department of Orthopedic Surgery, Southern Medical University, Nanfang Hospital, Guangzhou, China.

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis

Language

eng

PubMed ID

29618143

Citation

Dai, Wen-Li, et al. "Efficacy and Safety of Hylan Versus Hyaluronic Acid in the Treatment of Knee Osteoarthritis." The Journal of Knee Surgery, vol. 32, no. 3, 2019, pp. 259-268.
Dai WL, Lin ZM, Guo DH, et al. Efficacy and Safety of Hylan versus Hyaluronic Acid in the Treatment of Knee Osteoarthritis. J Knee Surg. 2019;32(3):259-268.
Dai, W. L., Lin, Z. M., Guo, D. H., Shi, Z. J., & Wang, J. (2019). Efficacy and Safety of Hylan versus Hyaluronic Acid in the Treatment of Knee Osteoarthritis. The Journal of Knee Surgery, 32(3), 259-268. https://doi.org/10.1055/s-0038-1641142
Dai WL, et al. Efficacy and Safety of Hylan Versus Hyaluronic Acid in the Treatment of Knee Osteoarthritis. J Knee Surg. 2019;32(3):259-268. PubMed PMID: 29618143.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy and Safety of Hylan versus Hyaluronic Acid in the Treatment of Knee Osteoarthritis. AU - Dai,Wen-Li, AU - Lin,Ze-Ming, AU - Guo,Dong-Hong, AU - Shi,Zhan-Jun, AU - Wang,Jian, Y1 - 2018/04/04/ PY - 2018/4/5/pubmed PY - 2019/5/22/medline PY - 2018/4/5/entrez SP - 259 EP - 268 JF - The journal of knee surgery JO - J Knee Surg VL - 32 IS - 3 N2 - The purpose of this study was to use meta-analytic approach to compare the efficacy and safety of intraarticular hylan and hyaluronic acid (HA) for knee osteoarthritis (OA) treatment. We searched PubMed, Embase, and the Cochrane databases through July 2017 to identify Level I randomized controlled trials (RCTs) that evaluated clinical efficacy and safety of hylan compared with HA for knee OA. The primary outcomes were Visual Analogue Scale (VAS) for pain and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, and WOMAC function scores. In each study and for the outcome measures (VAS for pain, WOMAC pain, function and stiffness scores, and Lequesne score), we calculated the treatment effect from the difference between the preintervention and postintervention changes in the hylan and HA groups. Twenty-one RCTs involving 3,058 patients were included. Pooled analysis suggested that compared with HA, hylan was associated with similar pain relief and function improvement in patients with knee OA (VAS for pain: mean difference [MD], -3.04; 95% confidence interval [CI], -9.13 to 3.04; p = 0.33; I 2 = 76%. WOMAC pain score: MD, 0.23; 95% CI, -0.25 to 0.70; p = 0.35; I 2 = 0%. WOMAC function score: MD, -0.47; 95% CI, -6.81 to 5.88; p = 0.88; I 2 = 84%). No significant difference was found comparing the patients with treatment-related adverse events. The relationship was robust in sensitivity analysis and consistent in most of the subgroup analyses. As to the primary outcomes (WOMAC pain, function scores, VAS for pain), the difference between hylan and HA did not reach the previously reported minimum clinically important difference (MCID) values (-13.4 for VAS for pain, -2.0 for WOMAC pain score, -7.7 for WOMAC function score). Our meta-analysis showed that there were no statistically and clinically significant differences in pain relief and function improvement between hylan and HA injections for knee OA treatment. In view of its higher costs, we discourage the use of hylan in patients with knee OA in clinical practice. The level of evidence is I, meta-analysis of Level I studies. SN - 1938-2480 UR - https://www.unboundmedicine.com/medline/citation/29618143/Efficacy_and_Safety_of_Hylan_versus_Hyaluronic_Acid_in_the_Treatment_of_Knee_Osteoarthritis_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-0038-1641142 DB - PRIME DP - Unbound Medicine ER -