The effectiveness of three weekly injections compared to five weekly injections of intra-articular sodium hyaluronate on pain relief of knee osteoarthritis or three weekly injections of other hyaluronan products: A Systematic Review and Meta-Analysis.

OBJECTIVE: To investigate whether the number of hyaluronic acid (HA) injections in a Hyalgan(®) course of therapy alters effectiveness in reducing knee osteoarthritis (OA) pain. DATA SOURCES: Electronic databases, including PubMed and EMBase, were searched from January 1980 until November 2015. STUDY SELECTION: We included clinical studies that evaluated the effectiveness of a course of three or five weekly intra-articular injections of Hyalgan to treat knee OA pain. We also included clinical studies evaluating the effectiveness of a three-week course of other FDA-approved HA treatments of knee OA pain. Twenty-four studies were identified, comprising 2,168 study participants in 30 treated cohorts. DATA EXTRACTION: We determined effect sizes for selected studies by extracting knee OA pain scores before and after HA or control treatments. Meta-regressions were implemented to determine whether the number of weekly injections in a course of Hyalgan therapy modified outcomes. DATA SYNTHESIS: The pooled estimate for relief from baseline pain was -31.4 (5.46 SE; 95% confidence interval [CI], -45.5, -17.4) with a three-week course of Hyalgan and -32.2 (5.25; CI, -45.6, -18.7) with a five-week course of Hyalgan. Findings from the meta-analysis indicate relief of knee OA pain with a three-week course of Hyalgan is similar to that with a five-week course of Hyalgan (P = .916). The pooled estimate for relief from baseline pain with a three-week course of other HA products was -29.4 (4.98; CI, -42.2, -16.6), also indicating pain relief with a three-week course of Hyalgan is similar to that with a three-week course of other HA products (P = .696). CONCLUSIONS: There was no statistical difference between reduction in knee OA pain with a three-week course of Hyalgan compared to reduction in knee OA pain with a five-week course of Hyalgan or a three-week course of other HA products. These findings demonstrate that comparable knee OA pain relief is achieved with a three-week course of Hyalgan and the two control groups.