Virtua team: Pricey new drug no better than old one for knee surgery pain

A relatively new, brand-name drug was about as effective as a long-available generic at relieving pain after knee replacement despite costing 25 times as much, a team of Virtua Health orthopedists reported, winning a national research award for their small study.

Orthopedic surgeon Rajesh K. Jain and colleagues from the Virtua Joint Replacement Institute in Voorhees measured post-operative pain earlier this year among 207 consecutive patients who were randomly assigned to three groups in advance. After the procedure, members of two of the groups received an injection of the standard localized pain reliever bupivicaine – a relative of novocaine – plus morphine, either near or directly into the joint. The other group received an injection near the joint of liposomal bupivicaine, a 72-hour, timed-release version of the drug that was approved by the Food and Drug Administration in 2011.  All three groups reported nearly identical levels of low, post-surgical pain on a standard measure, according to the research abstract.

The longer-acting medication, sold under the brand name Exparel, costs $402 a dose, Virtua said in a news release. The older drug costs about $16. The effectiveness of Exparel had previously been compared with placebo but this was the first head-to-head comparison with the generic treatment for total knee replacement, the authors wrote.

Rising drug prices have become a major concern for patients, insurers, and policymakers in recent years. Among the questions has been whether newer drugs that cost more are necessarily better than older, cheaper medications. Prescription pain relievers have also been in the news lately because they can lead to addiction and overdose but the drugs used in the knee replacement research were administered locally and would have minimal effect on the brain.

The new findings were presented during the annual meeting of the American Association of Hip and Knee Surgeons in Dallas on Saturday. The gathering, described as the largest meeting of joint replacement specialists in the world, honored the authors with the association's Clinical Research Award, one of three awards given for "outstanding papers" selected from nearly 1,300 submissions from the United States and Europe.

Virtua is one of New Jersey's largest health systems but pales in size to major medical research institutions in Philadelphia and elsewhere, a disparity that one of the abstract reviewers noted in a quotation released by the nonprofit system. "We are really are excited to see the Virtua [Joint Replacement Institute] submission because they know how hard it is to complete these studies with limited resources and compete with the large institutions," said reviewer Craig J. Della Valle, the association's education chairman.

Jain, the lead author and orthopedic section chief at Virtua, said in a statement: "The awards at this meeting are more commonly given to large institutions that have a lot of research funding, such as university hospitals or tertiary care centers."

"Our team is continually looking to do more clinical research because it helps shape what future healthcare will be."

Coauthors were Scott D. Schoifet, Manny D. Porat, Gregory G. Klingenstein, Jeremy J. Reid, and Robert E. Post. The Virtua Foundation funded the study.

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