An injectable and costly arthritis drug works no better than a cheap steroid, according to a new study at the Hospital for Special Surgery in New York City. Researchers found that Synvisc One and corticosteroids both provide effective pain relief to patients with thumb arthritis, but so did a placebo injection.
“On average, each of the therapies resulted in clinically meaningful improvement in pain,” said Lisa Mandl, MD, a rheumatologist at Hospital for Special Surgery who led the study. “What this study suggests is that a number of different injectable treatments might be effective for patients who have pain in their thumb and that the one that appeared to be the most effective was corticosteroids.”
The randomized double blind study, reported at the annual meeting of the American College of Rheumatology, involved 200 patients diagnosed with carpometacarpal osteoarthritis (CMC), also known as thumb arthritis. CMC osteoarthritis is common in people over 60. It occurs in 80% of women who are 80 years of age or older.
Patients were given injections of either Synvisc One, a corticosteroid called triamcinolone acentoide, or bupivacaine, a common local anesthetic that served as a placebo during the six month study.
Researchers found that each group showed a statistically and clinically significant improvement in pain levels, regardless of treatment. Patients who received the steroid had slightly greater improvements in pain compared to patients who received Synvisc One.
“Overall, this was a negative trial. If you compare the three treatments to each other, neither the steroid or Synvisc provided better pain relief than bupivacaine,” said Mandl. “Bupivacaine shouldn’t do anything. It should numb and wear out in 20 minutes, but even that seems to help some people. What this suggests is that maybe the injection itself is making people feel better.”
Mandl says physicians should consider trying any of the three treatments on patients with CMC.
“It may be that steroids are the most effective, so I would probably try steroids first. If that didn’t work, then I would try (Synvisc). If patients were hesitant to try either steroids or (Synvisc), I’d even try bupivacaine,” said Mandl.
Researchers say physicians and patients should weigh the pros and cons of the different treatments. Synvisc is long-acting and is usually prescribed once every six months. It acts as a lubricant for arthritic joints and costs about $600 for each treatment.
Corticosteroid injections cost only about $15 per treatment, but may need to be given repeatedly, which could damage the joint further or cause other complications.
Regardless of the cost, Mandl says even patients with very severe osteoarthritis would benefit from treatment.
“Even if you have a patient with terrible arthritis, it is worth trying one of these therapies,” she says. “There is no other therapy besides surgery for these people once they have failed other conservative measures.”
The study was partially funded by the Arthritis Foundation, the National Institutes of Health, and Genzyme, a division of the French drug maker Sanofi (NYSE: SNY). Genzyme, which makes Synvisc, provided the drug at no charge. Researchers say the company had no input into study design, analysis or interpretation of the data.