PMID- 31735075
OWN - NLM
STAT- MEDLINE
DCOM- 20220406
LR  - 20230917
IS  - 1947-6043 (Electronic)
IS  - 1947-6035 (Print)
IS  - 1947-6035 (Linking)
VI  - 13
IP  - 1_suppl
DP  - 2021 Dec
TI  - Safety of Intra-Articular Hyaluronic Acid for Knee Osteoarthritis: Systematic 
      Review and Meta-Analysis of Randomized Trials Involving More than 8,000 Patients.
PG  - 351S-363S
LID - 10.1177/1947603519888783 [doi]
AB  - OBJECTIVE: The objective of this systematic review and meta-analysis was to 
      report the safety of intra-articular hyaluronic acid (IAHA) in patients with 
      symptomatic knee osteoarthritis (OA). METHODS: We identified randomized 
      controlled trials reporting the safety of IAHA versus IA saline in adults with 
      symptomatic knee OA. Main safety outcomes were adverse events (AEs), local AEs, 
      serious adverse events (SAEs), study withdrawals, and AE-related study 
      withdrawals. RESULTS: A total of 35 randomized controlled trials with 38 group 
      comparisons comprising 8,078 unique patients (IAHA: 4,295, IA saline: 3,783) were 
      included in the meta-analysis. Comparing IAHA with IA saline over a median of 6 
      months follow-up, there were no differences in the risk of AEs (42.4% vs. 39.7%, 
      risk ratio [RR] = 1.01, 95% CI = 0.96-1.07, P = 0.61), SAEs (1.8% vs. 1.2%, RR = 
      1.44, 95% CI = 0.91-2.26, P=0.12), study withdrawals (12.3% vs. 12.7%, RR = 0.99, 
      95% CI = 0.87-1.12, P = 0.83), or AE-related study withdrawals (2.7% vs. 2.1%, RR 
      = 1.37, 95% CI = 0.97-1.93, P = 0.08). Local AEs, all of which were nonserious, 
      were more common with IAHA vs. IA saline (14.5% vs. 11.7%, RR = 1.21, 95% CI = 
      1.07-1.36, P = 0.003) and typically resolved within days. CONCLUSION: IAHA was 
      shown to be safe for use in patients with symptomatic knee OA. Compared with IA 
      saline, IAHA is associated with an increased risk of nonserious, transient local 
      reactions. There was no evidence to suggest any additional safety risks of IAHA.
FAU - Miller, Larry E
AU  - Miller LE
AUID- ORCID: 0000-0003-1594-1885
AD  - Miller Scientific Consulting, Inc., Asheville, NC, USA.
FAU - Bhattacharyya, Samir
AU  - Bhattacharyya S
AD  - DePuy Synthes, Raynham, MA, USA.
FAU - Parrish, William R
AU  - Parrish WR
AD  - DePuy Synthes, Raynham, MA, USA.
FAU - Fredericson, Michael
AU  - Fredericson M
AD  - Department of Orthopaedic Surgery, Division of Physical Medicine and 
      Rehabilitation, Stanford University Medical School, Stanford, CA, USA.
FAU - Bisson, Brad
AU  - Bisson B
AD  - DePuy Synthes, Raynham, MA, USA.
FAU - Altman, Roy D
AU  - Altman RD
AD  - Division of Rheumatology and Immunology, David Geffen School of Medicine, 
      University of California at Los Angeles, Los Angeles, CA, USA.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Systematic Review
DEP - 20191116
PL  - United States
TA  - Cartilage
JT  - Cartilage
JID - 101518378
RN  - 9004-61-9 (Hyaluronic Acid)
SB  - IM
MH  - Humans
MH  - *Hyaluronic Acid/adverse effects
MH  - Injections, Intra-Articular
MH  - *Osteoarthritis, Knee/drug therapy
MH  - Randomized Controlled Trials as Topic
PMC - PMC8808790
OTO - NOTNLM
OT  - hyaluronic acid
OT  - knee
OT  - meta-analysis
OT  - osteoarthritis
OT  - systematic review
COIS- Declaration of Conflicting Interests: The author(s) declared the following 
      potential conflicts of interest with respect to the research, authorship, and/or 
      publication of this article: L. Miller has an affiliation with DePuy Synthes that 
      is related to this study and with OsteoArthritis Centers of America that is not 
      related to this study. S. Bhattacharyya is an employee of DePuy Synthes. W. 
      Parrish is an employee of DePuy Synthes. M. Fredericson has an affiliation with 
      Ipsen that is not related to this study. B. Bisson is an employee of DePuy 
      Synthes. R. Altman has affiliations with GlaxoSmithKline, Novartis, Pfizer, 
      Sanofi, Sorrento, and Theralogix that are not related to this study.
EDAT- 2019/11/19 06:00
MHDA- 2022/04/07 06:00
PMCR- 2022/06/01
CRDT- 2019/11/19 06:00
PHST- 2019/11/19 06:00 [pubmed]
PHST- 2022/04/07 06:00 [medline]
PHST- 2019/11/19 06:00 [entrez]
PHST- 2022/06/01 00:00 [pmc-release]
AID - 10.1177_1947603519888783 [pii]
AID - 10.1177/1947603519888783 [doi]
PST - ppublish
SO  - Cartilage. 2021 Dec;13(1_suppl):351S-363S. doi: 10.1177/1947603519888783. Epub 
      2019 Nov 16.