Original Title: Efectividad y seguridad del ácido hialurónico en el tratamiento de la artrosis de rodilla, cadera y otras localizaciones articulares

Authors' objectives: • To identify, evaluate and synthesize the available scientific knowledge about the safety, effectiveness and cost-effectiveness of treatment with intra-articular hyaluronic acid for osteoarthritis of the knee, hip and other locations. • To determine the possible therapeutic differences between different types of commercial presentation of intra-articular hyaluronic acid. • To identify, evaluate and synthesize the available scientific knowledge about the possibility that treatment with Hyaluronic Acid delay or prevent the implantation of mechanical prostheses.

Authors' results and conclusions: RESULTS: Despite a significant increase in both the number and the quality of recently published papers on hyaluronic acid via intra-articular in people with osteoarthritis is observed, uncertainty remains about its effectiveness in its applications on the knee, which is the joint that has received most attention, and on the hip joint and other locations affected by arthritis. Despite the overall improvement in the quality of recent trials (improved statistical power), clinical heterogeneity of patients included, different formulas and strategies using hyaluronic acid (products, doses and treatment regimens), shortages in estimating the clinical relevance of the statistical results, the short duration of follow-up, and the heterogeneous choice of the comparison groups used, keep limiting the validity of the available information. On the few occasions in which RCTs provide statistically favorable results for intra-articular administration of hyaluronic acid versus placebo or other intra-articular products, these do not reach clinically relevant thresholds. Finally, the information provided on the frequency and magnitude of potential adverse events is poorly represented in the reviewed studies. The existence of reports of health technology assessment agencies recently published, free of conflict of interest, together with the findings drawn from systematic reviews and meta-analysis and scientifically robust recent reviews confirm the absence of clinical relevance for intra-articular administration of acid hyaluronic versus intra-articular administration of corticosteroids or placebo in the treatment of osteoarthritis of the knee, hip or other joint. There is no information demonstrating the effect of intra-articular administration of hyaluronic acid to slow the progression of osteoarthritis, or to delay or reduce the need for knee or hip replacement surgery.

Authors' recommendations: From the review of current scientific literature, intra-articular administration of hyaluronic acid should be considered as a therapy of low value to cope with osteoarthritis of the knee, hip and other locations. The available scientific knowledge does not justify recommending the use of intra-articular administration of hyaluronic acid routinely to treat the pain of osteoarthritis of the knee, hip or other locations. This recommendation is based on data comparing hyaluronic acid versus placebo and versus corticosteroids or other conservative therapies. The available studies also provide valid information about possible adverse effects, which adds uncertainty to the decision on funding the routine clinical use.

Authors' methods: This report applies the methodological proposals contained in the "EUnetHTA HTA adaptation toolkit" to update and adapt HTA reports pre-existing HTA for the Spanish NHS context. A literature search focused on secondary studies was performed, from April 2011 to February 28, 2015. The starting date is the date on which SESCS ended search for a previous report on the same technology and indications.

Project Status: Completed

Year Published: 2015

URL for published report: https://sescs.es/efectividad-y-seguridad-del-acido-hialuronico-en-el-tratamiento-de-la-artrosis/

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Spain

Organisation Name: Canary Health Service

Contact Address: Dirección del Servicio. Servicio Canario de la Salud, Camino Candelaria 44, 1ª planta, 38109 El Rosario, Santa Cruz de Tenerife

Contact Name: sescs@sescs.es

Contact Email: sescs@sescs.es