Intra-articular hyaluronans: the treatment of knee pain in osteoarthritis

Figures & data

Table 1 US-approved hyaluronan (HA) therapies: summary of product profiles

Product distributor	Manufacturing	Active ingredient	Number injections per course	Molecular weight (kDa)	Labeling precaution on efficacy/safety
Hyalgan (Sanofi-Aventis)	Naturally derived, purified HA	1% sodium hyaluronate (20 mg)	3 or 5	500–730	No
Synvisc (Genzyme Biosurgery)	Hylan polymers derived from HA	0.8% sodium hyaluronate derivative (16 mg)	1 (6 mL) or 3 (2 mL)	6000 + gel	No
Supartz (Smith and Nephew)	Naturally derived, purified HA	1% sodium hyaluronate (25 mg)	3 or 5	620–1170	Yes
Orthovisc (DePuy Mitek)	Naturally derived, purified HA	0.7% sodium hyaluronate (30 mg)	3 or 4	1100–2900	Yes
Euflexxa (Ferring)	Fermented, bacterial derived HA	1% sodium hyaluronate (20 mg)	3	2400–3600	Yes

Notes: Product profiles based on package insert of Hyalgan (2001), Synvisc (2006), Synvisc I (2008), Supartz (2004), Orthovisc (2005), Euflexxa (2005).

Table 2 Intra-articular hyaluronan therapy in knee osteoarthritis: summary of meta-analyses

Reference	Lo^Citation27	Wang^Citation29	Arrich^Citation26	Modawal^Citation28	Bellamy^Citation25
Total no. of studies	22	20	22	11	76
Efficacy outcome measures	Effect size (change from baseline pain vs placebo)	Mean difference, ASPID vs placebo	WMD in pain during/after exercise (VAS) vs control	VAS	WMD in pain on weight bearing vs placebo
Key pooled results	Effect size: 0.32 (P < 0.001)	Mean difference for ASPID: 13.4%	WMD 10–14 wk: −4.3 mm (P = 0.013) WMD 22–30 wk: −7.1 mm (P = 0.013)	WMD 5–7 wk: 17.6 (95% CI, +7.5, +28.0) 8–12 wk: 18.1 (95% CI, +6.3, +29.9) 15–22 wk: 4.4 (95% CI, −15.3, 24.1)	% Change 5–13 wk: +26% for pain; +23% for function
Conclusion	Small treatment effect	Safe and effective	Not effective in measured outcomes	Moderately effective at 5–10 wk, not effective at 15–22 wk	Effective treatment for pain, function, pt, global assessment at 5–13 wk

Abbreviations: ASPID, adjusted sum of pain intensity differences; WMD, weighted mean difference; VAS, visual analog scale; pt, patient.

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