Rheumatology News has an
article on a study telling us “Hyaluronic acid injection for knee OA as
effective as NSAIDs in short term” (Links are listed below).
The study is from Japan. It’s a multicenter, randomized, open-label,
parallel-group, non-inferiority comparison study. One group received a weekly
injection injection into the (one?) knee for five weeks and the other group
received three times 60 mg of loxoprofen, which is an NSAID of the same group
like ketoprofen or ibuprofen. Loxoprofen is only available in Japan, Mexico,
Brazil, Argentina, and India. The primary endpoint was the percentage change in
the patient-oriented outcome measure for knee OA, the Japanese Knee
Osteoarthritis Measure (JKOM) score. Rheumatology News tells about the
secondary endpoint: “and their percent change from baseline in pain as rated on
a 0- to 100-point visual analog scale
(VAS, secondary endpoint).”
Results: "The difference in the percentage changes of the JKOM
score between the two intervention arms (IA-HA; - 34.7 % (P < 0.001), NSAID;
- 32.2 % (P < 0.001)) was - 2.5 % (95 % confidence interval (CI): - 14.0 to 9.1),
indicating IA-HA was not inferior to NSAID. The frequency of both withdrawal and adverse events in the IA-HA group
were significantly lower than those in the NSAID group (P < 0.026 and 0.004,
respectively)."
The study tells us, that after five weeks of treatment the effects of hyaluronic
acid injection for knee OA is equal to an NSAID. How about the first two weeks?
Is hyaluronic acid working or the injection itself? Invasive manipulations have
a high percentage of placebo effect, but we do not have a placebo control
group. We don’t even know if the control group is disappointed not getting
their injections and therefore have less pain relief. Withdrawal in the NSAID
group had been higher, but the use of gastro protective agents has only been
allowed and not been mandatory.
The study has been perfectly done, but it fails to prove that hyaluronic
acid injection for knee OA is the road to follow.
Links:
Article on Rheumatology News - http://www.rheumatologynews.com/index.php?id=8844&tx_ttnews[tt_news]=235121&cHash=04c039bf543c2984f1ad4aa5f1b6af91&utm_medium=twitter&utm_source=twitterfeed
Abstract of the study - http://arthritis-research.com/content/16/1/R18/abstract
Loxoprofen on Wikipedia - http://en.wikipedia.org/wiki/Loxoprofen
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