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Benefit of Viscosupplementation for Knee OA Questioned

Small reduction in pain, increased risk for serious adverse events seen with viscosupplementation versus placebo for knee osteoarthritis

THURSDAY, July 14, 2022 (HealthDay News) — Viscosupplementation yields a small reduction in pain for knee osteoarthritis compared with placebo, which is less than the minimal clinically important between-group difference, according to a review published online July 6 in The BMJ.

Tiago V. Pereira, Ph.D., from the Li Ka Shing Knowledge Institute at St. Michael’s Hospital in Toronto, and colleagues conducted a systematic review and meta-analysis of randomized trials to examine the effectiveness and safety of viscosupplementation for pain and function in patients with knee osteoarthritis. Data were included from 169 trials with 21,163 randomly assigned participants.

The researchers found that based on 24 trials, with 8,997 randomly assigned participants, viscosupplementation was associated with a small reduction in pain intensity versus placebo (standardized mean difference [SMD], −0.08; 95 percent confidence interval, −0.15 to −0.02); the lower bound of the 95 percent confidence interval excluded the minimal clinically important between-group difference (−0.37). This effect corresponded with a −2.0 mm difference in pain scores on a 100-mm visual analog scale. In a sequential analysis of trials for pain, since 2009, there has been conclusive evidence of clinical equivalence between viscosupplementation and placebo. Based on 15 large placebo-controlled trials involving 6,462 participants, an increased risk for serious adverse events was seen with viscosupplementation versus placebo (relative risk, 1.49).

“Our findings do not support the broad use of viscosupplementation for the treatment of knee osteoarthritis,” the authors write.

One author disclosed financial ties to the pharmaceutical and medical device industries.

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