Инъекционные препараты гиалуроновой кислоты для лечения гонартроза с позиций доказательной медицины

Для оценки эффективности и безопасности внутрисуставного применения гиалуроновой кислоты (ГНК) при остеоартрите (ОА) проанализированы включенные в зарубежные базы данных (Medline/PubMed) научные публикации, посвященные актуальным лабораторным, экспериментальным и клиническим исследованиям, проведенным за последние 20 лет. Результаты немногочисленных лабораторных исследований (in vitro) отдельных препаратов ГНК подтверждают их положительное влияние на суставной хрящ. Анализ литературы, посвященной их применению in vivo, показал, что целый ряд разрешенных к применению в России препаратов ГНК для внутрисуставного введения не изучались в клинических исследованиях, что вызывает сомнения в их эффективности. В то же время опубликованные работы свидетельствуют о достижении значимого клинического эффекта терапии ГНК, преимущественно на ранней стадии ОА, и неудовлетворительных результатах ее применения при терминальном гонартрозе. Данные, касающиеся сопоставления клинической эффективности различных препаратов, весьма противоречивы. Таким образом, необходимы дополнительные постмаркетинговые сравнительные исследования разрешенных к применению в Российской Федерации препаратов ГНК со стратификацией пациентов в зависимости от особенностей клинического фенотипа заболевания, имеющихся факторов риска прогрессирования ОА, а также степени морфологических изменений тканей сустава, верифицированной при магнитно-резонансной томографии и/или артроскопии.

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