Evidence map›Paper›PMID 21443958›Full record

SynthesisOsteoarthritis and cartilage2011

Therapeutic trajectory following intra-articular hyaluronic acid injection in knee osteoarthritis--meta-analysis.

R R Bannuru, N S Natov, U R Dasi, C H Schmid, T E McAlindon

Registry-linked trialAbstract readMeta-AnalysisReview
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Osteoarthritis and cartilage, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02671565 (Comparative Effectiveness of Hyaluronic Acid Injections to Prevent/Delay Knee Surgical Interventions Among Patients With Knee Osteoarthritis), which is not on this map. Cited by 150 papers, 15 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
150citing papers in PubMed, 15 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02671565 completednot on this mapstarted 2016, after this paper: background citation

Comparative Effectiveness of Hyaluronic Acid Injections to Prevent/Delay Knee Surgical Interventions Among Patients With Knee Osteoarthritis

TypeobservationalSponsorUniversity of ArkansasRan2016 to 2016Enrolled13,849ConditionsKnee OsteoarthritisArmsHyaluronic Acid injections
3 · Its place in the literature

Who cites it

150 citing papers in PubMed, 15 syntheses or guidelines pooled it.

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90 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

R R BannuruTufts Medical Center, Boston, MA, USA.
N S Natov
U R Dasi
C H Schmid
T E McAlindon

Funding

TUFTS CLINICAL AND TRANSLATION SCIENCE INSTITUTE (UL1): BPCAUL1RR025752 · NCRR · TUFTS UNIVERSITY BOSTON · PI SELKER, HARRY P. · 2008 to 2011
$17.6M
POSTDOCTORAL FELLOWSHIPS IN HEALTH SERVICES RESEARCHT32HS000060 · AHRQ · TUFTS MEDICAL CENTER · PI SELKER, HARRY P. · 1993 to 2012
$2.9M
Modernizing Meta-Analysis to Facilitate Comparative Effectiveness ReviewsR01HS018574 · AHRQ · TUFTS MEDICAL CENTER · PI SCHMID, CHRISTOPHER H. · 2009 to 2011
$1.2M
AHRQ HHS R01 HS018574AHRQ HHS R01 HS018574-01AHRQ HHS T32 HS0000060AHRQ HHS T32 HS000060NCRR NIH HHS UL1 RR025752
6 · The paper itself

Abstract

objectiveTo evaluate the therapeutic trajectory of intra-articular hyaluronic acid (IAHA) vs placebo for knee osteoarthritis (OA).

designOur data sources include Medline, EMBASE, CINAHL, BIOSIS, Web of Science, Google Scholar, Cochrane database; hand searched reviews, manuscripts, and, supplements; author contacts for unpublished data. Randomized trials that reported effects of IAHA vs placebo on knee OA were selected based on inclusion criteria. We computed effect sizes for change from baseline at 4, 8, 12, 16, 20 and 24 weeks, using Bayesian random effects model. We performed multivariate analyses adjusting for correlation between time points. Meta-regressions were performed adjusting for potential confounders.

resultsThe 54 eligible trials included 7545 participants. The conduct and quality of these trials varied in number of aspects. The effect size (ES) favored IAHA by week 4 (0.31; 95% CI 0.17, 0.45), reaching peak at week 8 (0.46; 0.28, 0.65), and then trending downwards, with a residual detectable effect at week 24 (0.21; 0.10, 0.31). This therapeutic trajectory was consistent among the subset of high quality trials and on multivariate analysis adjusting for correlation between time points.

conclusionsOur meta-analysis highlights a therapeutic trajectory of IAHA for knee OA pain over 6 months post-intervention. With this additional perspective, we are able to infer that IAHA is efficacious by 4 weeks, reaches its peak effectiveness at 8 weeks and exerts a residual detectable at 24 weeks. On the other hand, the peak effect size (0.46; 0.28, 0.65), is greater than published effects from other OA analgesics [acetaminophen (ES=0.13; 0.04, 0.22); NSAIDs (ES=0.29; 0.22, 0.35); COX-2 inhibitors (ES=0.44; 0.33, 0.55)]. An effect size above 0.20 is considered to be clinically relevant on an individual patient basis in chronic pain conditions such as knee OA. Thus, its properties could have utility for certain clinical situations, or in combination with other therapies.

Indexed as

Adjuvants, ImmunologicHumansHyaluronic AcidInjections, Intra-ArticularModels, TheoreticalOsteoarthritis, KneePainRandomized Controlled Trials as TopicAdjuvants, ImmunologicHyaluronic Acid

Identifiers

PMID21443958
PMCPMC11678314

What OpenQuestion holds

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Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.