The management of knee osteoarthritis (OA) increasingly seeks solutions that are both effective and align with patient needs for convenience and reduced treatment burden. As conservative therapies prove insufficient for many patients, intra-articular viscosupplementation remains a key non-surgical option. The evolution within this field has seen a notable shift towards single-injection HA (hyaluronic acid) regimens, aiming to provide sustained symptom relief with fewer clinic visits.

Monovisc® (high molecular weight hyaluronan), developed by Anika Therapeutics, stands out as a prominent single-injection viscosupplement utilizing lightly cross-linked hyaluronic acid. This article details the clinical profile of Monovisc®, examining its unique formulation derived from bacterial fermentation, reviewing its efficacy and safety data, and discussing optimal patient selection, particularly highlighting the advantages of its single-injection protocol and non-avian HA source.

Monovisc® Formulation & Mechanism of Action

Monovisc® possesses distinct characteristics that inform its clinical use:

• Composition: It consists of sterile, non-pyrogenic sodium hyaluronate, characterized by a high molecular weight and achieved through light cross-linking. This formulation is designed to optimize viscoelastic properties within the joint space.¹
• Source: Bacterial Fermentation: A key differentiator for Monovisc® is its production via bacterial fermentation. This non-avian origin eliminates the risk of hypersensitivity reactions associated with avian-derived HA products (like Synvisc® or Hyalgan®), making it a suitable option for patients with known or suspected allergies to eggs, feathers, or poultry.^1,2
• Mechanism: Like other HA viscosupplements, Monovisc® aims to restore the natural viscoelastic properties of synovial fluid, providing lubrication and shock absorption.¹ Its rheological properties contribute to its intra-articular residence time. Potential biological effects, such as anti-inflammatory actions or chondrocyte stimulation, are also areas of ongoing research for HMW HAs.

Clinical Efficacy & Safety Data

The clinical utility of Monovisc® is supported by randomized controlled trials:

• Efficacy: Key studies have evaluated Monovisc® against saline control injections in patients with symptomatic knee OA. These trials demonstrated statistically significant improvements in primary endpoints, including reductions in WOMAC Pain scores and improvements in physical function, compared to control groups.²
• Duration of Effect: The clinical benefit of a single Monovisc® injection has been shown to persist for up to 6 months in responders, providing sustained symptom relief comparable to established multi-injection HA regimens.²
• Safety Profile: Monovisc® is generally well-tolerated. The most commonly reported adverse events are transient, mild-to-moderate local reactions at the injection site, such as arthralgia, joint swelling, and injection site pain.^1,2 Systemic adverse events are infrequent. The non-avian source minimizes the risk of allergic reactions seen with poultry-derived products. However, hypersensitivity to gram-positive bacterial proteins remains a contraindication.¹

Optimizing Patient Selection for Monovisc®

Identifying appropriate candidates is crucial for maximizing the benefits of Monovisc®:

• Ideal Candidate Profile: Patients with symptomatic knee OA (typically Kellgren-Lawrence Grade II-III) who meet the following criteria are often well-suited:
  • Failure to achieve adequate relief with conservative non-pharmacologic and simple analgesic therapies.
  • Preference for, or clinical need requiring, a single-injection regimen due to factors like patient compliance, convenience, travel constraints, or visit cost considerations.
  • Known or suspected avian allergies (eggs, feathers, poultry) where avian-derived HA viscosupplements are contraindicated.
• Contraindications: Patients should not receive Monovisc® if they have:¹
  • Active infections in or around the knee joint.
  • Skin diseases or infections at the injection site.
  • Known hypersensitivity to hyaluronate preparations.
  • Known hypersensitivity to gram-positive bacterial proteins (due to the bacterial fermentation source).
  • Significant bleeding disorders (use with caution).

Administration Protocol & Practice Integration

• Procedure: Monovisc® is administered as a single intra-articular injection into the knee joint space. Strict adherence to aseptic technique throughout the procedure is paramount.¹
• Volume: It is supplied in a standard 4mL pre-filled syringe, representing the full single treatment dose.¹
• Patient Counseling: Pre-injection counseling should cover the procedure and potential local reactions. Post-injection advice includes avoiding strenuous activity for approximately 48 hours and managing potential discomfort with ice or simple analgesics. Setting realistic expectations regarding the time course of symptom relief (often taking several weeks) is important.
• Practice Workflow: The single-visit protocol of Monovisc® can offer significant efficiency benefits for busy clinical practices compared to multi-injection regimens, reducing patient visits and administrative burden.

Positioning Monovisc® in the OA Treatment Paradigm

Monovisc® occupies a specific niche within the viscosupplementation landscape:

• vs. Multi-injection HA (e.g., Orthovisc®, Euflexxa®): The primary difference lies in the injection schedule. Monovisc® offers convenience, while multi-injection protocols may be preferred by some clinicians or patients, or dictated by reimbursement policies. Monovisc® shares the non-avian source advantage with its multi-injection counterpart, Orthovisc®.
• vs. Other Single-injection HA (e.g., Durolane®, Synvisc-One®): Comparisons involve nuances in formulation (degree and type of cross-linking, molecular weight, source – avian vs. non-avian) and the specific evidence base for each product. Monovisc®’s bacterial fermentation source is a key differentiator from avian-derived options like Synvisc-One®.
• Comprehensive Strategy: Monovisc® should be considered one component of a holistic OA management strategy, complementing physical therapy, weight management, patient education, and other appropriate interventions.

Conclusion

Monovisc® provides clinicians with a valuable and convenient single-injection viscosupplementation option for managing pain associated with knee osteoarthritis. Its key advantages include the simplified treatment schedule, potentially enhancing patient compliance, and its non-avian HA source derived from bacterial fermentation, making it suitable for patients with avian sensitivities.

Clinical evidence supports its efficacy in providing pain relief and functional improvement for up to six months in appropriately selected patients. Clinicians should consider Monovisc® based on individual patient needs, allergy profiles, treatment preferences, and the desire for a non-avian derived, single-injection HA therapy within a comprehensive OA management plan.

Doris Dickson

About the Author: Doris Dickson is a specialist writer for Health Supplies Plus, focusing on the aesthetic medicine industry. She diligently researches cosmetic treatments and products to provide clear, concise information relevant to licensed medical professionals. Her work supports Health Supplies Plus’s commitment to being a reliable informational resource and trusted supplier for the aesthetic community.

 

Disclaimer: The content provided in this article is intended for informational purposes only and is directed towards licensed medical professionals. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment, nor does it constitute an endorsement of any specific product or technique. Practitioners must rely on their own professional judgment, clinical experience, and knowledge of patient needs, and should always consult the full product prescribing information and relevant clinical guidelines before use. Health Supplies Plus does not provide medical advice.