PMID- 29496227
OWN - NLM
STAT- MEDLINE
DCOM- 20181221
LR  - 20181221
IS  - 1532-866X (Electronic)
IS  - 0049-0172 (Linking)
VI  - 48
IP  - 2
DP  - 2018 Oct
TI  - Efficacy and safety of repeated courses of hyaluronic acid injections for knee 
      osteoarthritis: A systematic review.
PG  - 168-175
LID - S0049-0172(17)30650-9 [pii]
LID - 10.1016/j.semarthrit.2018.01.009 [doi]
AB  - INTRODUCTION: Hyaluronic acid (HA) is a commonly prescribed intra-articular (IA) 
      therapy for knee osteoarthritis (OA). While a single series of IA-HA has been 
      well studied, the efficacy and safety of repeated courses of IA-HA injection 
      therapy in knee OA patients have not been evaluated as frequently. METHODS: A 
      literature search was conducted using MEDLINE, EMBASE and PubMed databases. The 
      primary outcome measure was knee pain reduction after each treatment course 
      and/or last reported follow-up visit. Secondary outcomes were treatment-related 
      adverse events (AEs) and serious adverse events (SAEs). RESULTS: A total of 17 
      articles (7 RCTs and 10 cohort studies) met the pre-defined inclusion criteria. 
      Of the RCTs, six were double-blind with two trials including open label extension 
      studies, and one was single-blind. Studies ranged from investigating a single 
      reinjection cycle to four repeat injection cycles. Eleven studies evaluated one 
      reinjection, five studies evaluated >/=2 repeated courses of IA-HA, and one study 
      allowed either one or two repeated courses. All studies reported pain reduction 
      from baseline in the IA-HA treatment group throughout the initial treatment 
      cycle, and either sustained or further reduced pain throughout the repeated 
      courses of treatment. The study with the longest follow-up repeated IA-HA 
      injection every 6 months for 25 months. Pain decreased after the first course and 
      continued to decrease until the end of the study, with an approximate 55% 
      reduction in pain compared to baseline. Common AEs were joint swelling and 
      arthralgia; there were no reported SAEs. All repeated courses were well 
      tolerated, and the number of documented AEs and SAEs was similar to the primary 
      injection regimens. CONCLUSION: Repeated courses of IA-HA injections are an 
      effective and safe treatment for knee OA. Repeat courses were demonstrated to 
      maintain or further improve pain reduction while introducing no increased safety 
      risk.
CI  - Copyright (c) 2018 The Authors. Published by Elsevier Inc. All rights reserved.
FAU - Altman, Roy
AU  - Altman R
AD  - Division of Rheumatology and Immunology, David Geffen School of Medicine, 
      University of California at Los Angeles, Los Angeles, CA. Electronic address: 
      journals@royaltman.com.
FAU - Hackel, Josh
AU  - Hackel J
AD  - Andrews Institute for Orthopaedics & Sports Medicine, FL.
FAU - Niazi, Faizan
AU  - Niazi F
AD  - Ferring Pharmaceuticals Inc., Parsippany, NJ.
FAU - Shaw, Peter
AU  - Shaw P
AD  - Ferring Pharmaceuticals Inc., Parsippany, NJ.
FAU - Nicholls, Mathew
AU  - Nicholls M
AD  - Virginia Mason Orthopaedics and Sports Medicine, Seattle, WA.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Systematic Review
DEP - 20180131
PL  - United States
TA  - Semin Arthritis Rheum
JT  - Seminars in arthritis and rheumatism
JID - 1306053
RN  - 0 (Viscosupplements)
RN  - 9004-61-9 (Hyaluronic Acid)
SB  - IM
MH  - Humans
MH  - Hyaluronic Acid/adverse effects/*therapeutic use
MH  - Injections, Intra-Articular
MH  - Knee Joint
MH  - Osteoarthritis, Knee/*drug therapy
MH  - Randomized Controlled Trials as Topic
MH  - Treatment Outcome
MH  - Viscosupplements/adverse effects/*therapeutic use
OTO - NOTNLM
OT  - Intra-articular hyaluronic acid (IA-HA)
OT  - Knee
OT  - Osteoarthritis (OA)
EDAT- 2018/03/03 06:00
MHDA- 2018/12/24 06:00
CRDT- 2018/03/03 06:00
PHST- 2017/09/28 00:00 [received]
PHST- 2018/01/11 00:00 [revised]
PHST- 2018/01/16 00:00 [accepted]
PHST- 2018/03/03 06:00 [pubmed]
PHST- 2018/12/24 06:00 [medline]
PHST- 2018/03/03 06:00 [entrez]
AID - S0049-0172(17)30650-9 [pii]
AID - 10.1016/j.semarthrit.2018.01.009 [doi]
PST - ppublish
SO  - Semin Arthritis Rheum. 2018 Oct;48(2):168-175. doi: 
      10.1016/j.semarthrit.2018.01.009. Epub 2018 Jan 31.