SynthesisAdvances in therapy2019
The Impact of Excluding Patients with End-Stage Knee Disease in Intra-Articular Hyaluronic Acid Trials: A Systematic Review and Meta-Analysis.
Synthesis in Advances in therapy, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 3 of them syntheses that pooled 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.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
20 citing papers in PubMed, 3 syntheses or guidelines pooled it, 37 citations in OpenAlex.
- Intra-articular Hyaluronic Acid Treatments for Knee Osteoarthritis: A Systematic Review of Product Properties.Cartilage · 2023Pooled it
- The use of platelet-rich plasma in studies with early knee osteoarthritis versus advanced stages of the disease: a systematic review and meta-analysis of 31 randomized clinical trials.Archives of orthopaedic and trauma surgery · 2023Pooled it
- Intra-articular injection of stromal vascular fraction for knee degenerative joint disease: a concise review of preclinical and clinical evidence.Science China. Life sciences · 2022Pooled it
- Comparing efficacy of a single intraarticular injection of platelet-rich plasma (PRP) combined with different hyaluronans for knee osteoarthritis: a randomized-controlled clinical trial.BMC musculoskeletal disorders · 2022Trial
- Comparing the Efficacy of Intra-Articular Single Platelet-Rich Plasma(PRP) versus Novel Crosslinked Hyaluronic Acid for Early-Stage Knee Osteoarthritis: A Prospective, Double-Blind, Randomized Controlled Trial.Medicina (Kaunas, Lithuania) · 2022Trial
- What is end-stage knee osteoarthritis? A scoping and narrative review.Osteoarthritis and cartilage open · 2026Article
- The Potential of Intra-Articular Therapies in Managing Knee Osteoarthritis: A Systematic Review.Clinics and practice · 2024Review
- A Review of Current Approaches to Pain Management in Knee Osteoarthritis with a Focus on Italian Clinical Landscape.Journal of clinical medicine · 2024Review
- Predictors of Clinical Benefit with Intra-articular Hyaluronic Acid in Patients with Knee Osteoarthritis - A Narrative Review.Current rheumatology reviews · 2024Review
- What We Should Expect from an Innovative Intra-Articular Hyaluronic Acid Product: Expert Opinion Based on a Comprehensive Review of the Literature.Journal of clinical medicine · 2023Article
- Platelet-Rich Plasma for Knee Osteoarthritis: What Does the Evidence Say?Drugs & aging · 2023Review
- The value of injectable viscoelastic supplements for joints.Skeletal radiology · 2023Review
- Hype or hope of hyaluronic acid for osteoarthritis: Integrated clinical evidence synthesis with multi-organ transcriptomics.Journal of orthopaedic translation · 2022Article
- Intraarticular Hyaluronic Acid Preparations for Knee Osteoarthritis: Are Some Better Than Others?Cartilage · 2021Review
- Comprehensive Review of Knee Osteoarthritis Pharmacological Treatment and the Latest Professional Societies' Guidelines.Pharmaceuticals (Basel, Switzerland) · 2021Review
- Knee Osteoarthritis Treatment Costs in the Medicare Patient Population.American health & drug benefits · 2020Article
- Intra-Articular Injection of Amniotic Membrane and Umbilical Cord Particulate for the Management of Moderate to Severe Knee Osteoarthritis.Orthopedic research and reviews · 2020Article
- Development and Prospect of Intra-Articular Injection in the Treatment of Osteoarthritis: A Review.Journal of pain research · 2020Review
- Cost-Effectiveness of Treating Early to Moderate Stage Knee Osteoarthritis with Intra-articular Hyaluronic Acid Compared to Conservative Interventions.Advances in therapy · 2020Article
- Enriched Peripheral Blood-Derived Mononuclear Cells for Treating Knee Osteoarthritis.Cell transplantationArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThe Kellgren-Lawrence (K-L) grade is the most commonly used measure of radiographic disease severity in knee osteoarthritis (OA). Studies suggest that intra-articular hyaluronic acid (IA-HA) should only be considered in cases of early stage knee OA. The purpose of this review was to determine if trials administering IA-HA in early-moderate knee OA patients demonstrated greater pain relief than studies that also included patients with end-stage disease.
methodsWe conducted a systematic search of the literature to identify randomized controlled trials (RCT) comparing IA-HA with saline injections and that diagnosed disease severity using the K-L grade criteria. The primary outcome was mean change in pain from baseline at 4-13 weeks and 22-27 weeks. Safety was evaluated on the total number of participants experiencing a treatment-related adverse event (AE).
resultsTwenty RCTs were included. In the early-moderate OA subgroup, the mean change in pain scores was statistically significant favoring IA-HA from baseline to 4-13 weeks [SMD = - 0.30, 95% CI - 0.44 to - 0.15, p < 0.0001] and within 22-27 weeks [SMD = - 0.27, 95% CI - 0.39 to - 0.16, p < 0.00001]. No significant differences were observed in the late OA subgroup. IA-HA was associated with a significantly greater risk of treatment-related AEs relative to saline in the late OA subgroup [RR = 1.76, 95% CI 1.16-2.67, p = 0.008].
conclusionIA-HA provides significant pain relief compared to saline for patients with early-moderate knee OA, compared to cohorts including patients with end-stage OA (KL grade 4), with no increase in the risk of treatment-related AEs, up to 6 months. Patients with end-stage disease had lower levels of pain relief and may be diluting study results if included in the treatment cohort.
fundingFerring Pharmaceuticals.
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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.