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. 2018 Jul;9(3):263-275.
doi: 10.1177/1947603517693043. Epub 2017 Feb 1.

Decision Algorithms for the Retreatment with Viscosupplementation in Patients Suffering from Knee Osteoarthritis: Recommendations from the EUROpean VIScosupplementation COnsensus Group (EUROVISCO)

Raghu Raman  1 , Yves Henrotin  2 , Xavier Chevalier  3 , Alberto Migliore  4 , Jörg Jerosch  5 , Jordi Montfort  6 , Hervé Bard  7 , Dominique Baron  8 , Pascal Richette  9 , Thierry Conrozier  10
Affiliations

Decision Algorithms for the Retreatment with Viscosupplementation in Patients Suffering from Knee Osteoarthritis: Recommendations from the EUROpean VIScosupplementation COnsensus Group (EUROVISCO)

Raghu Raman et al. Cartilage. 2018 Jul.

Abstract

Background Viscosupplementation (VS) is a symptomatic treatment of knee osteoarthritis. Although systematic reviews of its repeat use showed favorable benefit/risk ratio, no study has focused on the indication of retreatment. Methods A task force was created to look at issues regarding retreatment with VS in knee osteoarthritis. An attempt was made to reach consensus on several issues: (1) to define treatment "success" and "failure," (2) to determine when to retreat patients successfully treated by a previous VS, (3) to determine how to retreat patients in whom VS failed, (4) to define what to do in case of adverse reaction following previous VS, and (5) to examine the interests of soluble biomarkers to manage retreatment. After debate and review of literature the working group voted on 88 issues. Two "decision trees" were built based on the results of the votes. Results In case of failure, the authors draw attention to the need of a rigorous clinical and radiological analysis, and consider evidence-based medicine. When VS was previously successful, retreatment can be considered after recurrence or increase in pain. However, in subjects with high risk of disease progression, in young patients, and in professional sportsmen, retreatment could be considered systematically, because of the probability of hyaluronic acid to slow osteoarthritis progression. Evidence on soluble biomarkers was not considered as enough strong to support their use as decision tools for patient retreatment. Conclusion The decision algorithms are intended to facilitate consideration of the therapeutic options, in patients with knee osteoarthritis previously treated with VS.

Keywords: biomarkers; diagnosis; diagnostics; intraarticular delivery; joint involved; knee; osteoarthritis; procedures; therapeutic delivery; tissue lubrication.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Yves Henrotin received honorarium from Menarini, Flexion therapeutics, IBSA, BioIberica, Expansciences, Royal canin, MagPharm and LABRHA and Tilman SA, for consultant services; and is the founder and shareholder of KIOmed pharma and Artialis SA. Raghu Raman received honorarium from Sanofi and LABRA for consultant services. Pascal Richette received fees from BioIbérica, Fidia, IBSA, Expanscience, Genévrier, Sanofi, Rottapharm, Servier, Flexion Therapics, and Ménarini. Hervé Bard received speaker and expert fees from Sanofi, Rottapharm-Madaus, Pfizer, and LABRHA. Jörg Jerosch received honorarium from Sanofi for speaker services. Thierry Conrozier received honorarium from Genevrier, Aptissen Bioventus, and LABRHA for expert and consultant services. Xavier Chevalier received fees as a Genevrier Board member, Sanofi-Aventis expert, member of the IBSA fundation, speaker in IBSA meetings, Moebius and Flexion therapics consultant. Alberto Migliore received consulting fees from Abbvie, BMS, MSD, Fidia, Sanofi, IBSA, Pfizer, and LABRHA, for national and international studies and courses. Jordy Monfort received consulting fees from Sanofi and BioIberica. Dominique Baron received speaker fees from LCA and Expansciences.

Figures

Figure 1.
Figure 1.
Algorithm of recommendations for retreatment with viscosupplementation of patients after failure of a previous viscosupplementation.
Figure 2.
Figure 2.
Algorithm of recommendations for retreatment with viscosupplementation of patients improved by a previous viscosupplementation.
See this image and copyright information in PMC

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