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From The Medical Letter on Drugs and Therapeutics
December 4, 2018

Two New Intra-Articular Injections for Knee Osteoarthritis

JAMA. 2018;320(21):2262-2263. doi:10.1001/jama.2018.13134

The FDA has approved a single-injection hyaluronic acid gel (Durolane – Bioventus) and an extended-release (ER) formulation of the synthetic corticosteroid triamcinolone acetonide (Zilretta – Flexion) for intra-articular (IA) treatment of osteoarthritic knee pain.

Non-drug treatments such as exercise, weight loss, and physical therapy can relieve the pain of knee osteoarthritis (OA) in some patients. Oral acetaminophen has generally been the first drug used. It is less effective than full oral doses of nonsteroidal anti-inflammatory drugs (NSAIDs), but it has fewer adverse effects. Topical gel and solution formulations of the NSAID diclofenac (Voltaren Gel, Pennsaid, and others) appear to be modestly effective in reducing pain, with a low risk of systemic adverse effects. For patients who have inadequate responses or contraindications to systemic anti-inflammatory or analgesic drugs, IA corticosteroid and hyaluronic acid injections have been used as alternatives (Table).