Hylan versus hyaluronic acid for osteoarthritis of the knee: A systematic review and meta-analysis
Version of Record online: 29 NOV 2007
Copyright © 2007 by the American College of Rheumatology
Arthritis Care & Research
Volume 57, Issue 8, pages 1410–1418, 15 December 2007
How to Cite
Reichenbach, S., Blank, S., Rutjes, A. W. S., Shang, A., King, E. A., Dieppe, P. A., Jüni, P. and Trelle, S. (2007), Hylan versus hyaluronic acid for osteoarthritis of the knee: A systematic review and meta-analysis. Arthritis & Rheumatism, 57: 1410–1418. doi: 10.1002/art.23103
- Issue online: 29 NOV 2007
- Version of Record online: 29 NOV 2007
- Manuscript Accepted: 22 MAY 2007
- Manuscript Received: 6 FEB 2007
- Swiss National Science Foundation's National Research Program 53. Grant Numbers: 4053-40-104762/3, 3200-066378
- Swiss National Science Foundation. Grant Number: 3233-066377
To compare the effectiveness and safety of intraarticular high-molecular hylan with standard preparations of hyaluronic acids in osteoarthritis of the knee.
We performed a systematic review and meta-analysis of randomized controlled trials comparing hylan with a hyaluronic acid in patients with knee osteoarthritis. Trials were identified by systematic searches of Central, Medline, EMBase, Cinahl, the Food and Drug Administration, and Science Citation Index supplemented by hand searches of conference proceedings and reference lists (last update November 2006). Literature screening and data extraction were performed in duplicate. Effect sizes were calculated from differences in means of pain-related outcomes between treatment and control groups at the end of the trial, divided by the pooled standard deviation. Trials were combined using random-effects meta-analysis.
Thirteen trials with a pooled total of 2,085 patients contributed to the meta-analysis. The pooled effect size was −0.27 (95% confidence interval [95% CI] −0.55, 0.01), favoring hylan, but between-trial heterogeneity was high (I2 = 88%). Trials with blinded patients, adequate concealment of allocation, and an intent-to-treat analysis had pooled effect sizes near null. The meta-analyses on safety revealed an increased risk associated with hylan for any local adverse events (relative risk [RR] 1.91; 95% CI 1.04, 3.49; I2 = 28%) and for flares (RR 2.04; 95% CI 1.18, 3.53; I2 = 0%).
Given the likely lack of a superior effectiveness of hylan over hyaluronic acids and the increased risk of local adverse events associated with hylan, we discourage the use of intraarticular hylan in patients with knee osteoarthritis in clinical research or practice.