Saturday, March 13, 2004
Patients with knee osteoarthritis (OA) who are treated with hylan G-F 20 are more satisfied with their treatment after 6 months than those treated with intra-articular steroids, said the authors of Scientific Paper 158 on Thursday.
"The current management of OA is primarily based on symptomatic improvement, since no medical or surgical therapy has been shown convincingly to alter the rate of progression of joint damage. Non-steroidal anti-inflammatory drugs (NSAIDs) are considered a standard treatment for OA. However, a large number of patients cannot tolerate NSAIDS or develop serious complications. Many patients do not achieve a satisfactory clinical response to NSAID therapy as well," report the authors
"Recent therapeutic approaches in the management of knee OA have focused on the fact that synovial fluid from osteoarthritic joints is lower in elasticity and viscosity than that from normal joints. Viscosupplementation therapy is the injection of hyaluronan or its derivatives into an osteoarthritic joint to increase the elasticity and viscosity of the synovial fluid to normal or higher levels. However, the response with hyaluronan prepartions has been mixed and has requiried multiple injections to achieve any significant efficacy," they noted.
Chemical cross-linked hyaluronans, such as hylan G-F 20, were developed to overcome such limitations in viscosupplementation therapy. "While the efficacy of hylan G-F 20 has been demonstrated in multiple clinical trials, there is little data on its use in regular clinical care," said lead researcher Gurkirpal Singh, MD, of Palo Alto, Calif. "In addition, patient satisfaction is an important goal of medical treatment for knee OA, but there are few studies that systematically studied this outcome."
Reseachers in this study evaluated patient satisfaction of treatment with hylan G-F 20 (SynviscÒ) versus intra-articular steroids in routine orthopaedic practice, using the Measurement of Outcomes from Viscosupplementation Effectiveness Study (MOVE), a large naturalistic longitudinal observational cohort study of patients recruited primarily from practicing orthopaedic surgeons and designed to measure clinical, economic and humanistic outcomes. The study involved 1,301 patients being treated with hylan G-F 20 and 559 controls who received standard of care over 4 years. Patients reported treatment satisfaction of their knee OA on a 0 to 10 scale (0=totally dissatisfied, 10=extremely satisfied).
Six-month patient satisfaction data were available from 305 patients treated with hylan G-F 20 and 107 patients who were given intra-articular steroid treatments. Patients treated with hylan G-F 20 were more likely to be male (37 percent vs. 27 percent), but were similar in age (67 years vs. 66 years) and disease duration (8.1 years vs. 8.5 years) than those treated with intra-articular steroids, although these differences were not statistically significant.
The average (standard error) treatment satisfaction was better in the hylan G-F 20 treated group-6.0 (± 0.16) on the 0 to 10 scale-compared to patients treated with intra-articular steroids, 5.3 (± 0.28) (p=0.02).
According to Dr. Singh, "Previous knee OA studies have shown that hylan G-F 20 may provide a more durable response with no differences in tolerability than intra-articular corticosteroids. This may explain the greater patient satisfaction with hylan G-F 20 treatment in our cohort."
In addition to Dr. Singh, researchers included Bonnie Bruce, DrPH, MPH, RD, of Palo Alto, Calif.; Reiko Sato, PhD, of Collegeville, Penn., and David D. Waddell, MD, of Shreveport, La.
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