The Use of Intra-Articular Hyaluronic Acid in a Multimodal Approach - - PowerPoint PPT Presentation

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Apr 05, 2024 153 likes •252 views

The Use of Intra-Articular Hyaluronic Acid in a Multimodal Approach for Osteoarthritis Care ANALYSIS OF AN ADMINISTRATIVE DATABASE K A R I N A U T K I N A , P E T E R S H AW, FA I ZA N N I A Z I , J E F F R E Y RO S E N P R ES E N T E D

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The Use of Intra-Articular Hyaluronic Acid in a Multimodal Approach for Osteoarthritis Care

ANALYSIS OF AN ADMINISTRATIVE DATABASE

K A R I N A U T K I N A , P E T E R S H AW, FA I ZA N N I A Z I , J E F F R E Y RO S E N P R ES E N T E D BY SA M U E L D O N A

OSET 2017

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Disclos

sures

es

Samuel Dona, MD: No Financial Disclosures. Sports Medicine Fellow,

Atlantic Sports Health

Karina Utkina, Peter Shaw, and Faizan Niazi are employed by Ferring

Pharmaceuticals

Jeffrey Rosen: Advisory board member for Ferring Pharmaceuticals

and Flexion Therapeutics. Department of Orthopaedics & Rehabilitation, New York Presbyterian Queens; Weill Medical College of Cornell University

Research Funded by: Ferring Pharmaceuticals

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Background

Knee osteoarthritis (OA) is a progressive and degenerative disease that often leads to the

need for a total knee replacement (TKR) as the severity of the disease progresses.

Many non-surgical treatment options are available for the management of knee OA prior to

the need for TKR, including (but not limited to):

Bracing
Corticosteroids (CS)
Intra-articular hyaluronic acid (IA-HA) injections
Current research typically aims to identify the superiority of these available treatment
ptions, yet a multimodal approach is often what is prescribed and utilized by real-world

patients with knee OA.

Study Objective

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Methods

Retrospective facility, professional, and pharmacological claims analysis of the Blue Cross/

Blue Shield (BCBS) database from October 1st, 2010 - September 30th, 2015.

Study Design

Time from the first OA treatment code within the database to the time of TKR.

Outcomes

Kaplan-Meier survival analysis to determine the TKR-free survival of patients who received:
IA-HA injections alone
IA-HA and bracing
IA-HA and CS injection
IA-HA and both CS and bracing
Most patients were assumed to have typically taken simple analgesics during their OA

treatment regimen.

Data Analysis

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Results

181,631 patients were included in the analysis:

BHI Database

181,631

IA-HA alone

58,429

IA-HA + Brace

5,276

IA-HA + CS

106,412

IA-HA + Brace + CS

11,504

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Results

There is an apparent delay to TKR over a

3 year follow-up period, after which time the cohorts converge beyond 3 years.

Patients treated with HA alone had a

lower cumulative TKA-free rate compared to multimodal cohorts.

Patients treated with a combination of

HA with either CS OR bracing demonstrated similar results.

The greatest benefit for TKR-free

survival in HA + CS + Bracing patient cohort.

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Results

HA Alone HA + Brace HA+CS HA + Brace + CS 12 months N at Risk 26321 2852 69464 8782 N TKRs 7947 524 10977 910 % TKR-Free 80.30% 86.40% 87.60% 91.20% 24 months N at Risk 14018 1581 40666 5558 N TKRs 11876 914 21432 2059 % TKR-Free 65.80% 72.20% 72.20% 77.50% 36 months N at Risk 6775 769 21428 3059 N TKRs 13860 1140 27558 2905 % TKR-Free 54.00% 58.90% 59.00% 63.30% 48 months N at Risk 2412 262 8235 1195 N TKRs 14810 1242 30951 3418 % TKR-Free 43.30% 47.50% 46.40% 49.10%

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Results

This study is limited by the lack of clinical outcome measures and patient disease status due to the use of an administrative database. Analysis is limited to what has been previously collected, and the authorship team is unable to consider all relevant variables if they were not captured. This study is strengthened by the large sample size and comprehensive analysis of a very large administrative database. These results indicate that the use of multimodal treatment regimens may provide greater benefit in delaying the need for TKR within patients with knee OA.

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Conclusions

IA-HA provides distinct clinical benefit within a multimodal approach to treatment
f knee OA.

The greatest benefit was seen within the patients who had received all three

evaluated treatment options, followed by the groups who had received combined therapy of two interventions, and finally the group who had received IA-HA alone. 3

Future research should consider the use of multimodal therapy for the

management of knee OA instead of focusing on comparisons between individual treatment options.

IA-HA + Bracing + CS IA-HA + Bracing / IA- HA + CS IA-HA