Compared with placebo, viscosupplementation provided a small reduction in pain but increased risk of serious adverse events in patients with knee osteoarthritis, according to published results.
Using MEDLINE, EMBASE and CENTRAL databases, researchers performed a systematic review of 169 randomized trials that compared outcomes of intra-articular injections of hyaluronic derivatives, also known as viscosupplementation, with either a placebo or no intervention for 21,163 patients with knee OA. Median follow-up after the last injection was 13 weeks, according to the study. Outcomes included pain intensity, which was analyzed with a minimal clinically important between group difference of 0.37 standardized mean differences (SMD), as well as function and adverse events.
Overall, 24 placebo-controlled trials (n = 8,997 patients) were included in the main analysis of pain. Researchers found viscosupplementation was associated with a small reduction in pain intensity (SMD 0.08) and a difference in pain scores of 2 mm on a 100-mm VAS scale compared with placebo. However, researchers noted conclusive evidence of clinical equivalence between viscosupplementation and placebo for pain since 2009.
After reviewing the 15 placebo-controlled trials (n = 6,462 patients), which compared serious adverse events between the groups, researchers found 3.7% of patients who received viscosupplementation and 2.5% of patients who received placebo experienced a serious adverse event. They determined viscosupplementation was associated with a higher risk of serious adverse events compared with placebo (relative risk = 1.49).
“Strong conclusive evidence indicates that, among patients with knee OA, viscosupplementation is associated with a clinically irrelevant reduction in pain intensity and with an increased risk of serious adverse events compared with placebo,” the researchers wrote in the study. “Our findings do not support the broad use of viscosupplementation for the treatment of knee OA,” they wrote.