Rheumatology

doi: 10.25005/2074-0581-2021-23-4-520-531
COMPARATIVE CLINICAL AND PHARMACOECONOMIC ANALYSIS OF THE EFFICACY OF MODERN COMBINATION THERAPY IN PATIENTS WITH PRIMARY KNEE OSTEOARTHRITIS, STAGES I-III

A.D. Davlatzoda1, Yo.U. Saidov1, Kh.R. Makhmudov1, R.J. Jamolova2

1Department of Propedeutics of Internal Diseases, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan
2Department of Internal Medicine № 3, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan

Objective: To study and comparatively evaluate the clinical and cost-effectiveness of modern structure/disease modifying anti- osteoarthritis drugs (S/ DMOADs) and hyaluronic acid (HLA) in modern intensive treatment of the primary knee osteoarthritis (KOA), stages I-III.

Methods: A comparative clinical and pharmacoeconomic analysis (PEA) of the effectiveness of a 6-month course of modern S/DMOADs (Structum®, Artra®) in combination with intra-articular HLA preparations (Ostenil®) and symptom-modifying drugs (SMDs) including non-steroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids (GCs) was conducted in 103 patients with primary KOA, stages I-III.

Results: At the end of the study (after 6 months), in patients with primary KOA, stages I-III, a statistically significant improvement in all clinical, laboratory and instrumental parameters reflecting the severity and activity of the disease was verified. The gains were most clearly observed in patients with early stages of KOA (I-II).

Conclusion: Treatment with modern S/DMOADs (Structum®, Artra®) and HLA preparations (Ostenil®) and, symptomatically with (NSAIDs and GCs intraarticularly) in primary KOA patients, I-III stages demonstrates positive changes in all clinical and laboratory parameters (mainly in early stages of the disease). In addition, and no less critical, it considerably limits the use of NSAIDs. Therefore, treatment with Structum® of patients with early primary KOA is the most cost-effective.

Keywords: Primary osteoarthritis, knee joints, pharmacoeconomic analysis, Structum®, Artra®, Ostenil®, WOMAC index.

Download file:


References
  1. Nasonov EL. (red.) Revmatologiya: rossiyskiye klinicheskiye rekomendatsii [Rheumatology: Russian clinical guidelines]. Moscow, RF: GEOTАR-Media; 2019. 461 p.
  2. Karateev AE, Lila AM. Osteoartrit: sovremennaya klinicheskaya kontseptsiya i nekotorye perspektivnye terapevticheskie podkhody [Osteoarthritis: current clinical concept and some promising therapeutic approaches]. Nauchno-prakticheskaya revmatologiya. 2018;56(1):70-81. Available from: https://doi. org/10.14412/1995-4484-2018-70-81
  3. Lila AM, Alekseeva LI, Telyshev KA. Sovremennye podkhody k fenotipirovaniyu osteoartrita [Current approaches to osteoarthritis phenotyping]. Sovremennaya revmatologiya. 2019;13(2):4-8. Available from: https://doi. org/10.14412/1996-7012-2019-2-4-8
  4. Alekseeva LI. Razvitie problemy osteoartrita v Rossii [Development of the problem of osteoarthritis in Russia]. Opinion Leader. 2018;6:30-6.
  5. Alekseeva LI, Taskina EA, Kashevarova NG. Osteoartrit: epidemiologiya, klassifikatsiya, factory riska, diagnostika, lechenie [Osteoarthritis: epidemiology, classification, risk factors, and progression, clinical presentation, diagnosis, and treatment]. Sovremennaya revmatologiya.2019;13(2):9-21. Available from: https://doi.org/10.14412/1996-7012-2019-2-9-21
  6. Cross M, Smith E, Hoy D, Nolte S, Ackerman I, Fransen M, et al. The global burden of hip and knee osteoarthritis: Estimates from the global burden of disease 2010 study. Ann Rheum Dis. 2014;73(7):1323-30. Available from: https://doi. org/10.1136/annrheumdis-2013-204763
  7. Portyannikova OO, Tsvinger SM, Govorin AV, Romanova EN. Analiz rasprostranyonnosti i faktorov riska razvitiya osteoartrita v populyatsii [Analysis of the prevalence and risk factors of osteoarthritis in a population]. Sovremennaya revmatologiya. 2019;13(2):105-11. Available from: https://doi. org/10.14412/1996-7012-2019-2-105-111
  8. Balabanova RM, Dubinina TV, Dyomina AB, Krichevskaya OA. Zabolevaemost' boleznyami kostno-myshechnoy sistemy v Rossiyskoy Federatsii za 2015-2016 gg [The incidence of musculoskeletal diseases in the Russian Federation over 2015-2016]. Nauchno-prakticheskaya revmatologiya. 2018;56(1):15-21. Available from: https://doi.org/10.14412/1995-4484-2018-15-21
  9. Kashevarova NG, Alekseeva LI, Taskina YEA, Smirnov AV. Vedushchie faktory progressirovaniya osteoartrita kolennykh sustavov. Vliyanie simptomaticheskikh preparatov zamedlennogo deystviya na techenie zabolevaniya (5-letnee prospektivnoe issledovanie) [Leading factors in the progression of osteoarthritis of the knee joints. Effect of symptomatic delayed-release drugs on the course of the disease (5-year prospective study)]. Farmateka. 2017;7:40-5.
  10. Scanzello CR. Role of low-grade inflammation in osteoarthritis. Curr Opin Rheumatol. 2017;29(1):79-85. Available from: https://doi.org/10.1097/ BOR.0000000000000353
  11. Scanzello CR, Goldring SR. The role of synovitis in osteoarthritis pathogenesis. Bone. 2012;51(2):249-57. Available from: https://doi.org/10.1016/j. bone.2012.02.012
  12. Robinson WH, Lepus CM, Wang Q, Raghu H, Mao R, Lindstrom TM, et al. Low-grade inflammation as a key mediator of the pathogenesis of osteoarthritis. Nat Rev Rheumatol. 2016;12(10):580-92. Available from: https://doi. org/10.1038/nrrheum.2016.136
  13. Trifonova EP, Zonova EV, Sazonova OV. Kliniko-immunologicheskie osobennosti bol'nykh osteoartritom v sochetanii s ozhireniem, metabolicheskim sindromom i sakharnym diabetom 2-go tipa [Clinical and immunological features of patients with osteoarthritis in combination with obesity, metabolic syndrome, diabetes mellitus type 2]. Sibirskiy meditsinskiy zhurnal (Irkutsk). 2017;148(1):5-11.
  14. Alekseeva LI, Naumov AV. Vedenie osteoartrita s komorbidnost'yu v obshchey vrachebnoy praktike (klinicheskie rekomendatsii) [Management of comorbid osteoarthritis: clinical recommendations for general practitioners]. Doktor.Ru. 2017;5:51-69.
  15. Strebkova EA, Alekseeva LI. Osteoartroz i ozhirenie [Osteoarthritis and obesity]. Nauchno-prakticheskaya revmatologiya. Available from: https://doi. org/10.14412/1995-4484-2015-542-552
  16. Alekseeva LI, Taskina EA, Kashevarova NG, Sharapova EP, Anikin SG, Strebkova EA, i dr. Osteoartrit kolennykh sustavov i metabolicheskiy sindrom: novye podkhody k terapii [Knee osteoarthritis and metabolic syndrome: new approaches to therapy]. Nauchno-prakticheskaya revmatologiya. 2018;56(2):157-63. Available from: https://doi.org/10.14412/1995-4484-2018-157-163
  17. Vasilieva LV, Evstratova EF, Nikitin AV, Burdina NS, Lednyova VS. Differentsirovannyy podkhod v lechenii bol'nykh osteoartrozom s kardiovaskulyarnoy patologiey [Differentiated approach to treatment of osteoarthrosis in cardiovascular pathology]. Rossiyskiy kardiologicheskiy zhurnal. 2016;21(2):84-9. Available from: https://doi.org/10.15829/1560-4071-2016-2-84-89
  18. Rizoeva OR, Saidov YoU. Pervichnyy osteoartrit kolennykh sustavov: sovremennye podkhody k ranney diagnostike i otsenke komorbidnogo fona [Primary knee osteoarthritis: modern approaches to early diagnosis and evaluation of comorbidity]. Vestnik Avitsenny [Avicenna Bulletin]. 2019;21(4):618-24. Available from: https://doi.org/10.25005/2074-0581-2019-21-4-618-624
  19. Mayko OYu. Farmakoekonomicheskie aspekty primeneniya khondroitina sul'fata u bol'nykh osteoartrozom v ambulatornykh usloviyakh [Pharmacoeconomic aspects of using chondroitin sulfate in the outpatient treatment of patients with osteoarthritis]. Problemy standartizatsii v zdravookhranenii. 2020;3-4:72- 7. Available from: https://doi.org/10.26347/1607-2502202003-04072-077
  20. Kolbin AS, Vilyum IA, Balykina YuE, Proskurin MA. Analiz meditsinskikh tekhnologiy lecheniya osteoartroza kolennykh sustavov gialuronovoy kislotoy [Analysis of medical technologies for the treatment of knee osteoarthritis with hyaluronic acid]. Kachestvennaya klinicheskaya praktika. 2014;1:40-56.
  21. Byra J, Czernicki K. The effectiveness of virtual reality rehabilitation in patients with knee and hip osteoarthritis. J Clin Med. 2020;9(8):2639. Available from: https://doi.org/10.3390/jcm9082639
  22. Sarvilina IV, Galustyan AN, Khadzhidis AK, Sardaryan IS, Lavrov NV, Gromova OA, i dr. Sravnitel'nyy kliniko-ekonomicheskiy analiz primeneniya preparatov SYSADOA, soderzhashchikh khondroitina sul'fata ili vliyayushchikh na ego biosintez, dlya lecheniya patsientov s osteoartrozom kolennykh sustavov II stadii [Comparative clinical and economic analysis of using SYSADOA drugs containing chondroitin sulphate or influencing its biosynthesis in the treatment of patients with stage II knee osteoarthritis]. Sovremennaya farmakoekonomika i farmakoepidemiologiya. 2019;12(4):255-67. Available from: https://doi. org/10.17749/2070-4909.2019.12.4.255-266
  23. Dementyev AS, Zhuravlyova NI, Kochetkov SYu, Chepanova EYu. Revmatologiya: standarty meditsinskoy pomoshchi [Rheumatology: Standards of care]. Moscow, RF: GEOTAR-Mеdia; 2018. 512 p
  24. Olyunin YuA. Osteoartroz: sovremennye printsipy lecheniya i predposylki dlya razrabotki personifitsirovannoy terapii [Osteoarthritis: current treatment principles and prerequisites for the development of personified therapy]. Sovremennaya revmatologiya. 2016;10(3):81-6. Available from: https://doi. org/10.14412/1996-7012-2016-3-81-86
  25. Klementyeva VI, Chernyshova TV. Ul'trazvukovaya kartina u bol'nykh s nachal'nymi stadiyami gonartroza [Ultrasound picture in patients with the initial stages of gonarthrosis]. Voprosy organizatsii i informatizatsii zdravookhraneniya. 2016;(S):152-4.
  26. Kudinskiy DM, Smirnov AV, Alekseeva LI, Volkov AV, Taskina EA, Lila AM. Degenerativnye i vospalitel'nye izmeneniya v sustavakh kistey pri osteoartrite po dannym magnitno-rezonansnoy tomografii [Degenerative and inflammatory hand joint changes in osteoarthritis according to magnetic resonance imaging]. Nauchno-prakticheskaya revmatologiya. 2020;58(1):15-21. Available from: https://doi.org/10.14412/1995-4484-2020-15-21
  27. Luyten FP, Bierma-Zeinstra S, Dell'Accio F, Kraus VB, Nakata K, Sekiya I, et al. Toward classification criteria for early osteoarthritis of the knee. Semin Arthritis Rheum. 2018;47(4):457-63. Available from: https://doi.org/10.1016/j.semarthrit. 2017.08.006
  28. Voloshin VP, Eryomin AV, Sankaranarayanan SA, Yukaev MY, Sadovyy IV, Bardyugov PS, i dr. Issledovaniye effektivnosti deystviya preparata Khondrogard (khondroitina sul'fat) u patsientov s osteoartrozom [Study on effectiveness of Hondrogard (chondroitin sulfate) in patients with osteoarthritis]. Trudnyy patsient. 2015;13(3):29-33
  29. Belyaeva EA, Avdeeva OS. Effektivnost' kompleksnoy terapii s primeneniem in"ektsionnoy formy khondroitina sul'fata i gialuronata natriya pri osteoartrite kolennogo sustava [The effectiveness of complex therapy using the injectable form of chondroitin sulfate and sodium hyaluronate with osteoarthritis of the knee joint]. Terapevticheskiy arkhiv. 2019;91(5):96-102. Available from: https://doi.org/10.26442/00403660.2019.05.000213
  30. Mantovani V, Maccari F, Volpi N. Chondroitin sulfate and Glucosamine as disease modifying anti-osteoarthritis drugs (DMOADs). Curr Med Chem. 2016;23(11):1139-51. Available from: https://doi.org/10.2174/09298673236 66160316123749
  31. Denisov LN, Platova AI, Menshikova IV, Lila AM. Osteoartrit – aspekty farmakoterapii [Osteoarthritis: aspects of pharmacotherapy]. Sovremennaya revmatologiya. 2018;12(2):97-102. Available from: https://doi.org/10.14412/1996- 7012-2018-2-97-102
  32. Byalik VE, Makarov MA, Byalik EI, Makarov SA, Nesterenko VA, Nurmukhametov MR. Sravnenie effektivnosti preparatov gialuronovoy kisloty s razlichnoy molekulyarnoy massoy i v sochetanii s khondroitinsul'fatom v zavisimosti ot stadii osteoartrita kolennogo sustava [Comparing the efficacy of hyaluronic acid products with various molecular weights as mono and combined with chondroitin sulfate regimens in treatment of patients with stage I-III knee osteoarthritis]. Nauchno-prakticheskaya revmatologiya. 2020;58(5):560-9. Available from: https://doi.org/10.47360/1995-4484-2020-560-569
  33. Strebkova EA, Alekseeva LI. Effektivnost' vnutrisustavnoy terapii preparatami gialuronoy kisloty u bol'nykh osteoartritom [Efficiency of intra-articular hyaluronic acid therapy in patients with osteoarthritis]. Sovremennaya revmatologiya. 2019;13(2):96-104. Available from: https://doi.org/10.14412/1996- 7012-2019-2-96-104
  34. Denisov LN, Tsvetkova ES, Golubev GSh, Bugrova OV, Dydykina IS, Dubikov AI, i dr. Algoritm lecheniya osteoartrita kolennogo sustava Evropeyskogo obshchestva po klinicheskim i ekonomicheskim aspektam osteoporoza i osteoartrita (ESCEO) primenim v rossiyskoy klinicheskoy praktike: sovmestnoe zaklyuchenie vedushchikh rossiyskikh spetsialistov i ekspertov ESCEO po osteoartritu [The European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) algorithm for the management of knee osteoarthritis is applicable in Russian clinical practice: A joint opinionof leading Russian specialists and ESCEO experts on osteoarthritis]. Nauchno-prakticheskaya revmatologiya. 2016;54(6):641-53.
  35. Pelletier JP, Martel-Pelletier J, Rannou F, Cooper C. Efficacy and safety of oral NSAIDs and analgesics in the management of osteoarthritis: Evidence from real-life setting trials and surveys. Semin Arthritis Rheum. 2016;45(4 Suppl): S22-7. Available from: https://doi.org/10.1016/j.semarthrit.2015.11.009
  36. Hochberg MC, Martel-Pelletier J, Monfort J, Möller I, Castillo JR, Arden N, et al. Combined chondroitin sulfate and glucosamine for painful knee osteoarthritis: a multicentre, randomised, double-blind, non-inferiority trial versus celecoxib. Ann Rheum Dis. 2016;75(1):37-44. Available from: https://doi.org/10.1136/ annrheumdis-2014-206792
  37. Fransen M, Agaliotis M, Nairn L, Votrubec M, Bridgett L, Su S, et al. Glucosamine and chondroitin for knee osteoarthritis: A double-blind randomised placebo-controlled clinical trial evaluating single and combination regimens. Ann Rheum Dis. 2015;74(5):851-8. Available from: https://doi.org/10.1136/ annrheumdis-2013-203954
  38. Rizoeva OR, Saidov YoU, Makhmudov KhR. Sravnitel’naya kliniko-laboratornaya i instrumental’naya otsenka effektivnosti mono- i kombinirovannoy terapii terafleksom s ostenilom u bol’nykh pervichnym osteoartritom kolennykh sustavov [Comparative clinical laboratory and instrumental assessment of effectiveness of mono- and combined therapy of Teraflex with Ostenile in patients with primary knee osteoarthritis]. Vestnik Avitsenny [Avicenna Bulletin]. 2019;21(4):610-7. Available from: https://doi.org/10.25005/2074-0581-2019- 21-4-610-617
  39. Petukhov AI, Kornilov NN, Kulyaba TA. In’ektsionnye preparaty gialuronovoy kisloty dlya lecheniya gonartroza s pozitsiy dokazatel’noy meditsiny [Injectable hyaluronic acid drugs for the treatment of knee osteoarthritis in the context of evidence-based medicine]. Nauchno-prakticheskaya revmatologiya. 2018;56(2):239-48. Available from: https://doi.org/10.14412/1995-4484- 2018-239-248
  40. Yagudina RI, Zinchuk IYu, Litvinenko МM. Analiz «stoimosti bolezni»: vidy, metodologiya, osobennosti provedeniya v Rossiyskoy Federatsii [Cost of illness analysis: types, methodology, specifics in Russian Federation]. Farmakoekonomika. Sovremennaya farmakoekonomika i farmakoepidemiologiya. 2012;5(1):4-9.

Authors' information:


Davlatzoda Aslamkhon Davlat
Applicant of the Department of Propedeutics of Internal Diseases, Avicenna Tajik State Medical University
ORCID ID: 0000-0003-2239-7953
E-mail: aslamkhon.davlatzoda@gmail.com

Saidov Yor Umarovich
Doctor of Medical Sciences, Head of the Department of Propedeutics of Internal Diseases, Avicenna Tajik State Medical University
ORCID ID: 0000-0003-1432-9803
Author ID: 844625
SPIN: 1842-1931
E-mail: erumarovich@mail.ru

Makhmudov Khayom Ruziboevich
Candidate of Medical Sciences, Assistant of the Department of Propedeutics of Internal Diseases, Avicenna Tajik State Medical University
ORCID ID: 0000-0002-3583-9442
Author ID: 720314
SPIN: 1025-4700
E-mail: mahmudovkh@yandex.ru

Jamolova Rukhshona Jalolidinovna
Candidate of Medical Sciences, Associate Professor of the Department of Internal Medicine № 3, Avicenna Tajik State Medical University
ORCID ID: 0000-0002-3327-0459
Author ID: 1073934
SPIN: 7258-1450
E-mail: ruha13@mail.ru

Information about support in the form of grants, equipment, medications

The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:


Saidov Yor Umarovich
Doctor of Medical Sciences, Head of the Department of Propedeutics of Internal Diseases, Avicenna Tajik State Medical University

734003, Republic of Tajikistan, Dushanbe, Rudaki Ave., 139

Tel.: +992 (918) 694819

E-mail: erumarovich@mail.ru

Materials on the topic: