Multi-injection HA appears to be more effective than single-injection HA versus saline for knee OA .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2018;6(2):8 BMC Musculoskelet Disord. 2017 Dec 21;18(1):54230 blinded randomized controlled trials evaluating the use of hyaluronic acid injections in comparison to a placebo injection in patients with knee osteoarthritis were included in this systematic review and meta-analysis. The objective of this systematic review and meta-analysis was to compare the efficacy and safety of hyaluronic acid injections across different dosing regimens. At 3 months, data were available for 2-4 injection and 5+ injection groups. The 2-4 injection groups demonstrated significantly lower pain scores compared placebo (SMD -0.76 p<0.00001), while the 5+ injection groups did not demonstrate significantly lower pain compared to placebo (SMD -0.20; p=0.09). At 6 months, both the 2-4 injection group (SMD -0.36; p=0.008) and 5+ injection group demonstrated significantly lower pain compared to placebo (SMD -0.18; p=0.04). The single injection groups did not significantly reduce pain compared to placebo at 6 months (SMD -0.04; p=0.67). When looking at the incidence of adverse events, only the 5+ injection group demonstrated a significantly greater incidence compared to placebo (RR 1.67; p=0.02).
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Was the validity of all of the studies referred to in the text assessed with use of appropriate criteria (either in selecting the studies for inclusion or in analyzing the studies that were cited)?
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Ja = 1
Ungewiss = 0.5
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Die Bewertung der Berichtskriterien bewertet die Transparenz, mit der die Autoren die methodischen und studienspezifischen Merkmale der Studie in der Veröffentlichung angeben. Die Bewertung ist in fünf Kategorien unterteilt, die im Folgenden vorgestellt werden.
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Introduction
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Accessing Data
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Analysing Data
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Results
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Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Der Fragilitätsindex ist ein Instrument, das bei der Interpretation signifikanter Ergebnisse hilft und ein Maß für die Stärke eines Ergebnisses liefert. Der Fragilitätsindex gibt die Anzahl der aufeinanderfolgenden Ereignisse an, die zu einem dichotomen Ergebnis hinzugefügt werden müssen, damit das Ergebnis nicht mehr signifikant ist. Eine kleine Zahl steht für ein schwächeres Ergebnis und eine große Zahl für ein stärkeres Ergebnis.
Warum wurde diese Studie jetzt benötigt?
Injection therapies are a prominent topic in research of knee osteoarthritis treatment. Viscosupplementation with intra-articular injection of hyaluronic acid remains one of the most researched and controversial methods of treatment. There is a debate as to whether the number of HA injections administered significantly influences efficacy.
Was war die wichtigste Forschungsfrage?
In the treatment of knee osteoarthritis, is there a significant difference in effect on pain between single injection, 2-4 injection, and 5+ injection protocols when compared to placebo saline?
- Only data on 2-4 injection and 5+ injection groups were available at 3 months. The 2-4 injection groups demonstrated significantly lower pain scores compared placebo (6 studies; SMD -0.76 [95%CI -0.98, -0.53]; p<0.00001), but 5+ injection groups did not demonstrate significantly lower pain compared to placebo (3 studies; SMD -0.20 [95%CI -0.43, 0.03]; p=0.09).
- At 6 months, 2-4 injection groups (10 studies; SMD -0.36 [95%CI -0.63, -0.09]; p=0.008) and 5+ injection groups demonstrated significantly lower pain compared to placebo (6 studies; SMD -0.18 [95%CI -0.35, -0.01]; p=0.04); single injection groups did not significantly differ in pain scores to placebo (2 studies; SMD -0.04 [95%CI -0.20, 0.13]; p=0.67).
- The incidence of adverse events did not significantly differ between 1 injection groups and placebo (4 studies; RR 1.22 [95%CI 0.85, 1.75]; p=0.28), and 2-4 injection groups and placebo (4 studies; RR 0.97 [95%CI 0.86, 1.08]; p=0.57); 5+ injection groups demonstrated a significantly higher incidence of adverse events compared to placebo (5 studies; RR 1.67 [95%CI 1.09, 2.56]; p=0.02).
Was sollte ich mir besonders merken?
In knee osteoarthritis treatment, two to four IA HA injections demonstrated effective pain reduction compared to placebo at 3 and 6 months, without a significant increase in the rate of adverse events. Single IA HA injection did not reduce pain compared to placebo after 6 months, and while five or more IA HA injections demonstrated significant pain reduction compared to placebo at 6 months, they were also associated with a significantly greater incidence of adverse events.
Wie wird sich dies auf die Behandlung meiner Patienten auswirken?
The results of this study suggest that, currently, the most optimal IA HA injection protocol for knee osteoarthritis is 2-4 injections, given the balance between both efficacy and safety measures. Nonetheless, direct comparisons are required between different numbers of injections, as well as on subgroups of particular IA HA product characteristics, such as molecular weight and crosslinking.
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