Quantitative analysis of the efficacy and associated factors of intra-articular hyaluronic acid with respect to osteoarthritis symptoms: A systematic review of randomized trials and model-based meta-analysis.
Systematic Review
To quantitatively evaluate hyaluronic acid (HA) efficacy for osteoarthritis (OA) and identify potential responders who would benefit most from HA./r/nEmbase, MEDLINE (PubMed), and the Cochrane Library Central Register of Controlled Trials were searched from inception to March 13, 2023. A pharmacodynamic Bateman function model was used to quantitatively evaluate the efficacy characteristics of HA treatments as well as placebo, while a covariate model was employed to identify factors that significantly affected efficacy./r/nIn total, 24 101 participants with symptomatic or radiographic OA from 168 studies with aggregate data were included. Simulation analysis from the pharmacodynamic time-effect model showed that HA treatment effects plateaued at approximately 2 months. The final model analysis indicated that intra-articular injection of HA combined with corticosteroids (CS) (the Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] pain effect size [ES] = 4.4 [95% confidence interval {CI}: 3.0 to 5.7]) or platelet-rich plasma (PRP) (WOMAC pain ES = 4.0 [95% CI: 2.7 to 5.3]) achieved the best efficacy compared with other groups (contrast between meta-analyses: WOMAC pain ES = 1.9 [95% CI: 1.2 to 5.2]). Subgroups analysis showed that younger (age < 65), overweight (body mass index ≥ 25) knee OA patients, with more severe baseline symptoms and a lower Kellgren-Lawrence (KL) grade (≤ 2), could benefit more./r/nThe quantitative model suggested that HA interventions were statistically more effective than placebo, with participants receiving HA+ CS or PRP experiencing the best efficacy. Patients with lower age, higher weight, higher severity of baseline symptoms, and lower KL grade appeared to benefit more from HA treatment.
