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Knee OsteoarthritisNCT02671565

Comparative Effectiveness of Hyaluronic Acid Injections for Management of Knee Osteoarthritis

An observational study of Knee Osteoarthritis, run by University of Arkansas.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Osteoarthritis (OA) is a degenerative joint disease in which there is an imbalance between the breakdown and repair of the joint tissue. Intraarticular hyaluronic acid (HA) injections are used for the management of knee OA. Read more about this study

Who is it for?
Ages 40 to 100 years
Conditions the study is for
Knee Osteoarthritis
What is being tested?
Hyaluronic Acid injections
Type of treatment
Injection or infusion
How many people
13,849 participants
Where
No sites listed yet
Study dates
Feb 2016to Jul 2016
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 40 to 100 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: Patients with a moderate to severe knee OA identified by using a specialist visit along with recent history of pain medication use (proxy for moderate to severe pain)

Who may be able to join

  • Patients with a specialist visit (orthopedic surgeon, physical medicine and rehabilitation, orthopedic, physical therapy, and rheumatologist) will enter in cohort and the date of the first visit will be considered as index date.
  • Patients should have at least one claim with a primary diagnosis of knee osteoarthritis (ICD-9-Center for Medicare (CM) code 715.x6) on the index date
  • Patients with a specialist visit should have at least one claim for pain medications (NSAIDs or opioids) within 90 days prior to or on the day of visit.
  • The age of a patient should be at least 40 years on the date of their index date
  • Patients to have continuous eligibility for pharmacy and medical benefits for at least six months prior to their index diagnosis.
  • Patients to have at least three months of continuous eligibility for pharmacy and medical benefits after their index diagnosis.

Who cannot join

  • Patients with a procedure claim for HA or CS in the pre-index period
  • Patients with a procedure claim for knee OA surgical procedures (arthroscopic procedures, osteotomy, free-floating interpositional devices, partial and total knee replacement) in the pre-index period.
  • In order to focus on knee OA pain, patients with a claim for joint fusion, rheumatoid arthritis, knee fracture, post-traumatic arthritis, avascular necrosis, benign/malignant bone tumors and Paget's disease in the pre-index period will be excluded

About this study

Official title: Comparative Effectiveness of Hyaluronic Acid Injections to Prevent/Delay Knee Surgical Interventions Among Patients With Knee Osteoarthritis

Osteoarthritis (OA) is a degenerative joint disease in which there is an imbalance between the breakdown and repair of the joint tissue. Intraarticular hyaluronic acid (HA) injections are used for the management of knee OA. Currently, there is limited and inconclusive evidence supporting use of HA injections for management of knee OA. The primary objective of our study is to evaluate the effectiveness of HA injections in the management of knee OA. Investigators will evaluate if HA injections prevent or delay knee OA surgical interventions.

Read the detailed description

Osteoarthritis (OA) is a degenerative joint disease in which there is an imbalance between the breakdown and repair of the joint tissue.Intraarticular hyaluronic acid (HA) injections are used for the management of knee OA. The pooled estimates of randomized clinical trials in various meta-analyses do not have consistent conclusions, some conclude no benefit while others conclude small benefit (reducing the pain or improving the daily functioning) to overall benefit (alleviating pain as well as improving daily functioning).The variation in conclusions is due to the heterogeneity in the methodology of the clinical trials included in these meta-analyses as well as a difference in the interpretation of clinical findings.Furthermore, most of the trials (63%) evaluating efficacy of HA are industry funded, raising the concern for publication bias. Furthermore Although the evidence favoring the use of HA injections is limited, these injections still have a significant market share with an annual sale of $725 million per year. Given the high dollar amount spent on the intervention, evaluation of its effectiveness in real world setting is important. Currently, there is limited and inconclusive evidence supporting use of HA injections for management of knee OA. The primary objective of the current study is to evaluate the effectiveness of HA injections in the management of knee OA. Specifically, the investigators will compare the risk of any surgical intervention of knee as a primary outcome among the knee OA patients who are exposed to HA injections with those who are not exposed to HA injections (HA non-users) and those who are exposed to intra-articular corticosteroid (CS) injections. Three separate outcome definitions, which includes: i) composite surgical outcome measure (includes total knee replacement, partial knee replacement, arthroscopic procedures, osteotomy and free-floating inter-positional devices), ii) total and partial knee replacements only and iii) total knee replacement (TKR) only will be used to compare the effectiveness of HA users with HA non-users and CS users.

This study will be conducted using knee OA patients aged 40 years and above from the Lifelink Plus claims data (2006-2015). Knee OA patients with a specialist visit and a recent history of medications used for pain management (proxy for moderate-severe pain) will be identified. Patients will be classified into 3 groups: 1) HA users, 2) CS users and 3) HA non-users based on exposure/non-exposure to these interventions within first 90 days after specialist visit. HA users will be matched separately with two comparison (CS users and HA non-users) groups using a propensity score matching approach to reduce the imbalance between the intervention and comparison group. HA users will be matched separately to each comparison group (1:1 ratio) using a greedy matching approach within a predefined caliper (0.2 of the pooled standard deviation of the logit of the PS). Cox models will be used to compare the risk of 1) any surgical interventions for knee, 2) TKR and partial knee replacements only and 3) TKR only, among HA users and the comparison groups. For both comparisons, investigators will use four approaches to compare the risk of each outcome measure: 1) Unadjusted bivariate analysis, 2) Adjusted multivariate analysis, 3) Propensity score-matched sample and 4) Inverse probability weighting (IPW) using propensity score.

Being tested
Hyaluronic Acid injections
Keywords
Intraarticular hyaluronic acid injections, Total knee replacement, Observational study, Intraarticular corticosteroid injections, Comparative effectiveness
Medical subject headings
Osteoarthritis, Knee

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Hyaluronic Acid injectionsDrug

    Also called Synvisc, Orthovisc, Euflexxa, Monovisc, Hyglan or Supartz

Study groups in NCT02671565
Study groupRoleWhat they receive
Hyaluronic acid (HA) injection usersPatients with at least one procedure claim for intra-articular administration of hyaluronic acid (procedure codes: J7320, J7322, J7325, Q4084, J7317, Q4083, J7321, Q4085, J7323, Q4086, J7324, J7327, J7326) within 90 days after their first specialist (physical medicine, physical therapy, orthopedic surgeon, rheumatologist or orthopedic) visit will be considered as HA users.
Receives: Drug: Hyaluronic Acid injections
Corticosteroids (CS) injections usersPatients with at least one procedure claim for intra-articular administration of corticosteroids (procedure codes: J1020, J1030, J1040, J1094, J1100, J2920, J2930, J0702, J0704, J3300, J3301, J3302, J3303, J1700, J1710, J1720, J2650, J2920, J2930) within 90 days after their first specialist (physical medicine, physical therapy, orthopedic surgeon, rheumatologist or orthopedic) visit will be considered as CS users.
HA non-usersPatients who do not have any claims for procedural or surgical intervention including HA and CS injections in first 90 days after their first specialist visit will be considered as HA non-users

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Number of patients with any knee surgical intervention assessed using the inpatient and outpatient claims in the follow up time

    Each patient will be followed after index date + 90days until the date of his/her first arthroscopic procedure, osteotomy, placement of a free-floating interpositional device, partial or total knee replacement, the study end date, or until the subject is no longer enrolled. The number of events and follow up time will be used to calculate hazard ratios in order to assess the risk of surgical intervention for each comparison

    Measured: Person follow up time between 2006-2015

Secondary outcomes (2)
  1. Number of patients with total or partial knee replacement assessed using the inpatient and outpatient claims in the follow up time

    Each patient will be followed after index date + 90days until the date of his/her first total or partial knee replacement, the study end date, or until the subject is no longer enrolled. The number of events and follow up time will be used to calculate hazard ratios in order to assess the risk of total or partial knee replacement for each comparison

    Measured: Person follow up time between 2006-2015

  2. Number of patients with total knee replacement assessed using the inpatient and outpatient claims in the follow up time

    Each patient will be followed after index date + 90days until the date of his/her first TKR, the study end date, or until the subject is no longer enrolled. The number of events and follow up time will be used to calculate hazard ratios in order to assess the risk of total knee replacement for each comparison

    Measured: Person follow up time between 2006-2015

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted2 Feb 2016 (estimated)
  2. Study startFeb 2016
  3. Primary completionJul 2016
  4. Study completionJul 2016

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Retrospective
Enrolment
13,849 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02671565
Sponsor's protocol ID
204982
Status last verified
Aug 2016
First submitted
20 Jan 2016
Last updated
5 Aug 2021
Results posted
No
Data monitoring committee
No

Publications

  • Litwic A, Edwards MH, Dennison EM, Cooper C. Epidemiology and burden of osteoarthritis. Br Med Bull. 2013;105:185-99. doi: 10.1093/bmb/lds038. Epub 2013 Jan 20.

    PubMed 23337796
  • Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J, Towheed T, Welch V, Wells G, Tugwell P; American College of Rheumatology. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 2012 Apr;64(4):465-74. doi: 10.1002/acr.21596.

    PubMed 22563589
  • Arrich J, Piribauer F, Mad P, Schmid D, Klaushofer K, Mullner M. Intra-articular hyaluronic acid for the treatment of osteoarthritis of the knee: systematic review and meta-analysis. CMAJ. 2005 Apr 12;172(8):1039-43. doi: 10.1503/cmaj.1041203.

    PubMed 15824412
  • Medina JM, Thomas A, Denegar CR. Knee osteoarthritis: should your patient opt for hyaluronic acid injection? J Fam Pract. 2006 Aug;55(8):669-75. No abstract available.

    PubMed 16882439
  • Bannuru RR, Natov NS, Obadan IE, Price LL, Schmid CH, McAlindon TE. Therapeutic trajectory of hyaluronic acid versus corticosteroids in the treatment of knee osteoarthritis: a systematic review and meta-analysis. Arthritis Rheum. 2009 Dec 15;61(12):1704-11. doi: 10.1002/art.24925.

    PubMed 19950318
  • Lo GH, LaValley M, McAlindon T, Felson DT. Intra-articular hyaluronic acid in treatment of knee osteoarthritis: a meta-analysis. JAMA. 2003 Dec 17;290(23):3115-21. doi: 10.1001/jama.290.23.3115.

    PubMed 14679274
  • Wang CT, Lin J, Chang CJ, Lin YT, Hou SM. Therapeutic effects of hyaluronic acid on osteoarthritis of the knee. A meta-analysis of randomized controlled trials. J Bone Joint Surg Am. 2004 Mar;86(3):538-45. doi: 10.2106/00004623-200403000-00012.

    PubMed 14996880
  • Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G. Intraarticular corticosteroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2006 Apr 19;(2):CD005328. doi: 10.1002/14651858.CD005328.pub2.

    PubMed 16625636
  • Printz JO, Lee JJ, Knesek M, Urquhart AG. Conflict of interest in the assessment of hyaluronic acid injections for osteoarthritis of the knee: an updated systematic review. J Arthroplasty. 2013 Sep;28(8 Suppl):30-33.e1. doi: 10.1016/j.arth.2013.05.034. Epub 2013 Jul 24.

    PubMed 23890521
  • Bannuru RR, Natov NS, Dasi UR, Schmid CH, McAlindon TE. Therapeutic trajectory following intra-articular hyaluronic acid injection in knee osteoarthritis--meta-analysis. Osteoarthritis Cartilage. 2011 Jun;19(6):611-9. doi: 10.1016/j.joca.2010.09.014. Epub 2011 Apr 9.

    PubMed 21443958

Questions about this trial

What is this clinical trial studying?

An observational study of Knee Osteoarthritis, run by University of Arkansas.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 5 Aug 2021. Status can change between updates, so confirm with the study contact before making plans.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Number of patients with any knee surgical intervention assessed using the inpatient and outpatient claims in the follow up time (time frame: Person follow up time between 2006-2015). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02671565, which also lists 10 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 5 Aug 2021.

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