title: An integrated analysis of five double-blind, randomized controlled trials evaluating the safety and efficacy of a hyaluronan product for intra-articular injection in osteoarthritis of the knee.
abstract: OBJECTIVE
  Five double-blind, randomized, saline-controlled trials (RCTs) were included in the United States marketing application for an intra-articular hyaluronan (IA-HA) product for the treatment of osteoarthritis (OA) of the knee. We report an integrated analysis of the primary Case Report Form (CRF) data from these trials.
  
  
  METHODS
  Trials were similar in design, patient population and outcome measures - all included the Lequèsne Algofunctional Index (LI), a validated composite index of pain and function, evaluating treatment over 3 months. Individual patient data were pooled; a repeated measures analysis of covariance was performed in the intent-to-treat (ITT) population. Analyses utilized both fixed and random effects models. Safety data from the five RCTs were summarized.
  
  
  RESULTS
  A total of 1155 patients with radiologically confirmed knee OA were enrolled: 619 received three or five IA-HA injections; 536 received "placebo" saline injections. In the active and control groups, mean ages were 61.8 and 61.4 years; 62.4% and 58.8% were women; baseline total Lequèsne scores 11.03 and 11.30, respectively. Integrated analysis of the pooled data set found a statistically significant reduction (P < 0.001) in total Lequèsne score with hyaluronan (HA) (-2.68) vs placebo (-2.00); estimated difference -0.68 (95% CI: -0.56 to -0.79), effect size 0.20. Additional modeling approaches confirmed robustness of the analyses.
  
  
  CONCLUSIONS
  This integrated analysis demonstrates that multiple design factors influence the results of RCTs assessing efficacy of intra-articular (IA) therapies, and that integrated analyses based on primary data differ from meta-analyses using transformed data.
authors.affiliation: Division of Immunology and Rheumatology, Stanford University, Palo Alto, CA, USA.
authors.forename: V
authors.initials: V
authors.lastname: Strand
authors.forename: P G
authors.initials: PG
authors.lastname: Conaghan
authors.forename: L S
authors.initials: LS
authors.lastname: Lohmander
authors.forename: A D
authors.initials: AD
authors.lastname: Koutsoukos
authors.forename: F L
authors.initials: FL
authors.lastname: Hurley
authors.forename: H
authors.initials: H
authors.lastname: Bird
authors.forename: P
authors.initials: P
authors.lastname: Brooks
authors.forename: R
authors.initials: R
authors.lastname: Day
authors.forename: W
authors.initials: W
authors.lastname: Puhl
authors.forename: P A
authors.initials: PA
authors.lastname: Band
mesh_terms: D000368:Aged; D004311:Double-Blind Method; D004335:Drug and Narcotic Control; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000188:drug therapy*; D010146:Pain / Q000139:chemically induced; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D006820:Hyaluronic Acid