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Retrospective Comparative Analysis of Opioid Use and Intra-Articular Corticosteroid Injections Before and After Initial Treatment of Knee Osteoarthritis with Hylan G-F 20

Authors Khangulov V, Zhang X, Munson SH, Peyerl F, Rey F

Received 13 January 2020

Accepted for publication 14 May 2020

Published 3 June 2020 Volume 2020:12 Pages 79—85

DOI https://doi.org/10.2147/OARRR.S245766

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Chuan-Ju Liu


Victor Khangulov,1 Xuan Zhang,1 Sibyl H Munson,1 Fred Peyerl,1 Francoise Rey2

1Department of Health Economics and Outcomes Research, Boston Strategic Partners, Inc., Boston, MA, USA; 2Sanofi, Paris, France

Correspondence: Victor Khangulov 15 Graham Street #2, Jersey City, NJ 07307, USA
Tel +1-646-397-9420
Email vkhangulov@gmail.com

Background: Knee osteoarthritis (OA) is a painful condition affecting > 250 million people worldwide and is a leading cause of disability. Intra-articular (IA) corticosteroids and/or oral opioids are often recommended for the management of knee OA pain. There are, however, concerns regarding their safety and tolerability.
Study Question: Do patients diagnosed with knee OA show a decrease in opioids or IA corticosteroid injections prescribed/administered in hospitals following hylan G-F 20 treatment?
Study Design: This case-crossover, retrospective study using Health Facts®, a de-identified electronic health records database, enrolled patients ≥ 18 years with knee OA treated with hylan G-F 20 between January 1, 2000 and March 31, 2016, with data within 6 months before/after treatment.
Measures and Outcomes: Primary endpoints compared days on opioids, amounts of opioids, and number of IA corticosteroid injections before/after hylan G-F 20 treatment via paired t-tests.
Results: A total of 513 patients were qualified for analysis. In the opioid cohort, the average total number of days on opioids (N = 50; 5.0 vs 13.5 days; P = 0.007) and average total amount of opioids (N = 44; 165.4 morphine mg equivalents [MME] vs 493.7 MME; P = 0.013) were lower 6 months after hylan G-F 20 treatment than 6 months before treatment. In the IA corticosteroid cohort, the average number of IA corticosteroid injections decreased after hylan G-F 20 treatment (N = 36; 0.56 in the 6-month follow-up vs 1.39 before treatment; P < 0.0001). Additional time frames of 1– 5 months before and after treatment were examined; similar conclusions were drawn for patients with > 2 months of data.
Conclusion: Patients with knee OA previously treated with opioids or IA corticosteroid injections who received hylan G-F 20 demonstrated statistically significant decreases in these medications > 2 months following hylan G-F 20 treatment versus > 2 months before treatment.

Keywords: corticosteroids, opioids, osteoarthritis, viscosupplementation, hyaluronic acid, hylan G-F 20

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