To the Editor: In their meta-analysis, Dr Lo
and colleagues1 concluded that intra-articular
hyaluronic acid has a small beneficial effect compared with saline and suggested
that publication bias had overestimated the therapeutic effect. We have several
concerns about their methods.
First, the authors examined only 22 published studies, including some
with products not approved for use in the United States, and did not account
for excluded data. Sodium hyaluronate, however, has been evaluated in more
than 60 trials, 55 of which have been published. These trials have involved
more than 5000 patients. Many of these were randomized, saline-controlled
trials that demonstrated a significant benefit for sodium hyaluronate.2
Moskowitz R, Altman R. Intra-articular Hyaluronic Acid for Treatment of Osteoarthritis of the Knee. JAMA. 2004;291(12):1440. doi:10.1001/jama.291.12.1440-b
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