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Hyaluronan for knee osteoarthritis: an updated meta-analysis of trials with low risk of bias.

Richette P, Chevalier X, Ea HK, Eymard F, Henrotin Y, Ornetti P, Sellam J, Cucherat M, Marty M - RMD Open (2015)

Bottom Line: The effectiveness of intra-articular hyaluronic acid (IAHA) injection for knee osteoarthritis (KOA) is debated.The treatment effect was summarised with the standardised mean difference (SMD) calculated from differences in means of pain and function measures between treatment and control groups at 3 months.IAHA significantly reduced the pain intensity (SMD=-0.21, 95% CI (95% CI) -0.32 to -0.10) and improved function (SMD=-0.12, 95% CI -0.22 to -0.02).

View Article: PubMed Central - PubMed

Affiliation: Université Paris Diderot, UFR Médicale, Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière, Fédération de Rhumatologie , Paris , France ; Inserm U1132, Hôpital Lariboisière , Paris , France.

ABSTRACT

Background: The effectiveness of intra-articular hyaluronic acid (IAHA) injection for knee osteoarthritis (KOA) is debated.

Objectives: To evaluate the effect of IAHA for patients with KOA by analysing data from trials of IAHA versus placebo with low risk of bias, to provide the highest level of evidence.

Methods: A systematic review and meta-analysis was conducted. Randomised controlled trials (RCTs) with a low risk of bias (adequate randomisation and concealment and double-blind design) that investigated IAHA versus placebo (saline solution) injection were eligible. The primary efficacy measure was pain intensity and secondary outcome function at 3 months. The treatment effect was summarised with the standardised mean difference (SMD) calculated from differences in means of pain and function measures between treatment and control groups at 3 months. Trials were pooled by a random-effects model with DerSimonian and Laird weights. Statistical heterogeneity was explored by a visual exploration of forest plots and the I(2) statistic.

Results: A total of eight RCTs (2 199 randomised patients) met our inclusion criteria. IAHA significantly reduced the pain intensity (SMD=-0.21, 95% CI (95% CI) -0.32 to -0.10) and improved function (SMD=-0.12, 95% CI -0.22 to -0.02). Trials showed no heterogeneity.

Conclusions: This meta-analysis of high-quality trials of IAHA versus placebo shows that IAHA provides a moderate but real benefit for patients with KOA.

No MeSH data available.


Related in: MedlinePlus

Forest plot of differences in function expressed as effect size (standardised mean difference) at 12 weeks (5 trials).
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RMDOPEN2015000071F3: Forest plot of differences in function expressed as effect size (standardised mean difference) at 12 weeks (5 trials).

Mentions: Five trials contributed to the MA of function-related outcomes. The SMD was −0.12 (95% CI −0.22 to −0.02), which corresponds to an OR of 0.80; we found no heterogeneity among trials (I2=0% and τ2=0.0) (figure 3).


Hyaluronan for knee osteoarthritis: an updated meta-analysis of trials with low risk of bias.

Richette P, Chevalier X, Ea HK, Eymard F, Henrotin Y, Ornetti P, Sellam J, Cucherat M, Marty M - RMD Open (2015)

Forest plot of differences in function expressed as effect size (standardised mean difference) at 12 weeks (5 trials).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4613148&req=5

RMDOPEN2015000071F3: Forest plot of differences in function expressed as effect size (standardised mean difference) at 12 weeks (5 trials).
Mentions: Five trials contributed to the MA of function-related outcomes. The SMD was −0.12 (95% CI −0.22 to −0.02), which corresponds to an OR of 0.80; we found no heterogeneity among trials (I2=0% and τ2=0.0) (figure 3).

Bottom Line: The effectiveness of intra-articular hyaluronic acid (IAHA) injection for knee osteoarthritis (KOA) is debated.The treatment effect was summarised with the standardised mean difference (SMD) calculated from differences in means of pain and function measures between treatment and control groups at 3 months.IAHA significantly reduced the pain intensity (SMD=-0.21, 95% CI (95% CI) -0.32 to -0.10) and improved function (SMD=-0.12, 95% CI -0.22 to -0.02).

View Article: PubMed Central - PubMed

Affiliation: Université Paris Diderot, UFR Médicale, Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière, Fédération de Rhumatologie , Paris , France ; Inserm U1132, Hôpital Lariboisière , Paris , France.

ABSTRACT

Background: The effectiveness of intra-articular hyaluronic acid (IAHA) injection for knee osteoarthritis (KOA) is debated.

Objectives: To evaluate the effect of IAHA for patients with KOA by analysing data from trials of IAHA versus placebo with low risk of bias, to provide the highest level of evidence.

Methods: A systematic review and meta-analysis was conducted. Randomised controlled trials (RCTs) with a low risk of bias (adequate randomisation and concealment and double-blind design) that investigated IAHA versus placebo (saline solution) injection were eligible. The primary efficacy measure was pain intensity and secondary outcome function at 3 months. The treatment effect was summarised with the standardised mean difference (SMD) calculated from differences in means of pain and function measures between treatment and control groups at 3 months. Trials were pooled by a random-effects model with DerSimonian and Laird weights. Statistical heterogeneity was explored by a visual exploration of forest plots and the I(2) statistic.

Results: A total of eight RCTs (2 199 randomised patients) met our inclusion criteria. IAHA significantly reduced the pain intensity (SMD=-0.21, 95% CI (95% CI) -0.32 to -0.10) and improved function (SMD=-0.12, 95% CI -0.22 to -0.02). Trials showed no heterogeneity.

Conclusions: This meta-analysis of high-quality trials of IAHA versus placebo shows that IAHA provides a moderate but real benefit for patients with KOA.

No MeSH data available.


Related in: MedlinePlus