https://orcid.org/0000-0003-0013-3199
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Abstract
Background
Multiple interventions may be used to treat symptomatic knee osteoarthritis (OA), but concerns have been raised about the safety and efficacy of some therapies. Clinical trials have shown that hyaluronic acid (HA) can provide pain relief up to 6 months and possibly to 12 months, while real-world data has shown that pain medication and intra-articular corticosteroid (CS) injection utilization are reduced within 6 months after HA.
Objective
To examine changes in prescription pain medication and CS utilization during 1 year after multimodal therapy that included high molecular weight, bio-fermentation derived HA (Bio-HA) use for knee OA.
Methods
Commercial and Medicare Supplemental claims data (IBM MarketScan Research Databases) (1 January 2012, through 31 December 2018) was used to identify unilateral Bio-HA patients using multimodal therapy (any combination of CS injection, opioids, and non-opioid pain medication). Monthly therapy utilization was compared in the 12 months after Bio-HA therapy initiation to the 4-month intra-multimodal period.
Results
A total of 13,999 patients underwent Bio-HA therapy with concurrent multimodal therapy. The number of filled opioid prescriptions decreased from 2,913.0/month to 2,861.5/month after Bio-HA, with a reduction in mean monthly prescriptions from 0.60 to 0.43 per user (p < 0.001). A number of opioid days supplied also decreased from 48,914/month to 39,730/month, with a decrease from 10.1/month to 6.0/month per user (p < 0.001). Bio-HA patients had prescription pain medication-free days for 71% of the time post-multimodal period compared to 53% during the intra-multimodal period (p < 0.001). The proportion of patients with CS injections after Bio-HA decreased from 53.8% to 29.6% (p < 0.001). Total monthly CS injections decreased from 2,292 to 663.
Conclusions
Our data suggest that high molecular weight Bio-HA, as part of multimodal therapy, may be effective in providing longer-term pain relief with the reduction in pain therapy (CS injections and opioids) and increase in prescription pain medication-free days.
© 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group
Transparency
Declaration of funding
Exponent, Inc. received funding from Ferring Pharmaceuticals Inc. for this study. Role of sponsor: Two of the authors (FN, WNN) are employees of the study sponsor and were involved in the design of the study, interpretation of data, critical revision of the manuscript, and the decision to submit the report for publication. The study sponsor was not involved in the collection and analysis of the data or initial drafting of the paper.
Declaration of financial/other interests
KO reports other from Ferring Pharmaceuticals, during the conduct of the study; other from Bioventus, Medtronic, Stryker Orthopaedics, Sanofi, Pacira Pharmaceuticals, St. Jude Medical, Relievant Medsystems, the International Society for the Advancement of Spine Surgery, SI-Technology, LLC, Zimmer Biomet, Joerns Healthcare, SpineFrontier, ot Ethicon, DJO, Ossur, Karl Storz Endoscopy-America, Rex Medical, Smith & Nephew, and Covidien, outside the submitted work. SK reports grants from Ferring Pharmaceuticals, during the conduct of the study; grants from Stryker, Zimmer Biomet, Invibio, Wright Medical Technology, Ceramtec, Celanese, Ferring Pharmaceuticals, Formae, Lima Corporate, SINTX Technologies, Orthoplastics, Osteal Therapeutics, 3Spine, DJO Global, Carbofix, DePuy Synthes, other from Exponent, Inc., outside the submitted work. MN has nothing to disclose. FN reports being employed by Ferring Pharmaceuticals Inc. WN was an employee of Ferring Pharmaceuticals. EL reports other from Ferring Pharmaceutical, during the conduct of the study; other from Osteal Therapeutic, Ceramtec Inc., and Relievant Medsystem Inc., outside the submitted work. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.