Evaluation of the Evolution of Biological and Imaging Markers of Bone and Cartilage Degradation in Patients With Knee Osteoarthritis Receiving Intra-articular Injections of a Hyaluronan Derivative HYMOVIS®
Evaluation of the Evolution of Biological and Imaging Markers of Bone and Cartilage Degradation in Patients With Knee Osteoarthritis Receiving Intra-articular Injections of a Hyaluronan Derivative HYMOVIS®
This pilot study MOKHA is aimed to evaluate the beneficial effect of HYMOVIS® on cartilage of
 patients suffering of knee osteoarthritis as revealed by using scientifically sound,
 objective measurements of biological and MRI-based imaging markers.
This study is a post-marketing, open-label, prospective and multicentric pilot study in 50
 patients suffering from knee OA. Investigators will be rheumatologists or articular disease
 specialists from public or academic hospitals located in Belgium and France. In each
 investigating center, the same injector will perform all the VS.
Inclusion Criteria:

 -  Male or female between the age of 40 and 80 with BMI ≤ 40

 -  Monolateral (unless contralateral knee is grade I and asymptomatic) femorotibial knee
 OA associated or not with femoropatellar knee OA

 -  Responding to clinical and radiological criteria of the American College of
 Rheumatology (ACR) (Appendix 1)

 -  Symptomatic for more than 6 months in the most painful knee

 -  Radiological Kellgren & Lawrence (K&L) II or III in radiographs from less than 12
 months (Appendix 2)

 -  Mean knee pain score at rest over the last 24 hours evaluated on VAS (0-100) ≥ 40
 (Appendix 3) with a washout period for Paracetamol and oral NSAIDs depending on the
 half-life of the drug (Appendix 4). The most painful knee is considered.

 -  Able to follow the instructions of the study

 -  Having signed an ICF

 Exclusion Criteria:

 Related to the OA pathology

 -  Bilateral (except asymptomatic and grade I) OA of the knee

 -  Radiological K&L grade I or IV (Appendix 2)

 -  Chondromatosis or villonodular synovitis of the knee

 -  Recent trauma (< 1 month) of the knee responsible of the symptomatic knee

 -  Acute inflammatory OA (KOFUS (Knee Osteoarthritis Flare Up Scale) score ≥ 7, Appendix
 5)

 -  Articular disease resulting from articular dysplasia, aseptic osteonecrosis,
 acromegaly, Paget's disease, hemophilia, hemochromatosis….

 -  Inflammatory disease i.e. rheumatoid arthritis, gout, infectious arthritis, acute
 calcium pyrophosphate arthritis

 -  Pathologies interfering with the evaluation of OA (radiculalgia in the lower limbs,
 arteritis…..)

 -  Presence of another joint (other than the target knee) affected by OA (confirmed in
 radiographs and symptomatic)

 Related to treatments

 -  Corticosteroids injection in the target knee in the last month before first injection

 -  Hyaluronan injection in the target knee in the last 6 months before first injection

 -  Arthroscopy and surgery in the target knee in the last 6 months before first injection

 -  Oral corticotherapy ≥ 5mg/day (in Prednisone equivalent) in the last 3 months before
 first injection

 -  OA treatments based on curcuma extract (e.g. FLEXOFYTOL) in the last 3 months before
 first injection

 -  Change in the dosage of SYSAD i.e. chondroitin, glucosamine, diacerein or avocado-soy
 unsaponifiables in the last 3 months before first injection

 -  Paracetamol and oral NSAIDs before inclusion and follow-up visits (washout period
 depending on the half-life of the drug, Appendix 4).

 -  Osteoporosis-related treatments based on strontium ranelate, selective
 estrogen-receptor modulator (SERM) and parathormone (PTH) in the last 12 months before
 first injection

 -  An anticipated need for any forbidden OA treatments during the trial

 -  Contraindications to HYMOVIS®: hypersensitivity to the product components and
 infections or skin diseases in the area of the injection site.

 -  Non-pharmacologic therapy (including physical therapy) for the lower extremities
 initiated in the month before first injection

 -  Anticoagulant (coumarinic compound) and heparin

 Related to associated diseases

 -  Severe diseases (liver or renal failure, lung/heart disease, tumor, HIV….)

 -  Allergy or contra-indication to hyaluronan

 -  Severe alteration of mobility enabling functional evaluation

 -  High risk of hemorrhage and risk of infection at the site of injection

 -  Anticipated need for any surgical or other invasive procedure during the trial
 including prosthesis in the target knee

 Related to patients

 -  Participation to a therapeutic clinical trial in the last 3 months before first
 injection

 -  Under guardianship or judicial protection

 -  Pregnancy, breastfeeding, planned conception, premenopausal women without
 contraception, tubal ligation or hysterectomy

 Related to MRI counter-indication

 -  Patient with a pacemaker, an implantable defibrillator, neurosurgical clips, a
 neurostimulator, cochlear implant, a stent from less than 3 weeks, an insulin pump

 -  Patient with a ferromagnetic splinter in the body, or having wire sutures

 -  Serious mobility problem (Parkinson, tremors),

 -  Claustrophobia