The news is particularly auspicious for older patients who are at greater risk for NSAID-related events.
Intra-articular hyaluronic acid (IAHA) may be a good alternative to oral NSAIDs for treating knee osteoarthritis (OA), especially for older patients who are at a greater risk for NSAID-related adverse events, according to a meta-analysis.
The analysis of 5 randomized controlled clinical trials, published between 1995 and 2012, found no significant differences between IAHA and continuous oral NSAIDs in improving function and relieving pain and stiffness in knee OA at 4 and 12 weeks. IAHA also turned in a better safety profile.
Altogether, the trials randomized 357 patients to weekly injections of an FDA-approved IAHA (Synvisc, Hyalgan, Suplasyn, Suvenyl) or a saline placebo. Patients (n=355) assigned to receive an NSAID (diclofenac, naproxen, loxoprofen, or placebo) did so for up to 26 weeks.
Three of the trials were double-blinded and one 5-week trial was not placebo-controlled. The majority of the trial participants were women (range of 36%-68%) and the age range was from 61 to 67.
The most common adverse reaction for the IAHAs was injection site pain, but there were no “pseudoseptic reactions.” Serious GI adverse events, such as drug-related GI bleed, were more common with NSAIDs, reported the analysts from Tufts Medical Center in Boston who carried out the meta-analysis.
Among the limitations they noted for their own conclusion: the small number of trials included, their short duration, the fact that different IAHAs and NSAIDs were used.
Also, all 5 trials were sponsored by manufacturers of hyaluronic acid.
Bannuru RR, Vaysbrot EE, Sullivan MC, McAlindon TE. Relative efficacy of hyaluronic acid in comparison with NSAIDs for knee osteoarthritis: A systematic review and meta-analysis. Semin Arthritis Rheum. (2013) Published online November 11. [Epub ahead of print] (Abstract)