Synvisc cross-reaction?

[Mister Mxyzptlk]

Advertisement - Members don't see this ad

I was referred a patient who had an allergic reaction to Synvisc, asking me to use one of the synthetic preparations. In reviewing the prescribing materials they all say to avoid use if there has been a previous reaction to hyaluronate derivatives.

Any experience with this? I don't think the products are that much different, mostly a matter of molecular size.

 

[jj337]

Had one yesterday allergic to Synvisc and gets one of the synthetic versions without problem... I don't know if n=1 helps...

 

[Jcm800]

I was referred a patient who had an allergic reaction to Synvisc, asking me to use one of the synthetic preparations. In reviewing the prescribing materials they all say to avoid use if there has been a previous reaction to hyaluronate derivatives.

Any experience with this? I don't think the products are that much different, mostly a matter of molecular size.

Isnt Euflexxa the only "completely" synthetic... but i think this only applies if you are allergic to chicken...

I think if you have a problem, its gonna be hard to defend...i would avoid. but im a scaredy cat

 

[ParaVert]

Not a crazy idea to send to immunologist for skin testing. Tiny skin wheal of Synvisc may help rule out the unlikely notion of her actually being allergic.

Patients are clueless about what allergies are. Can't tell you how many people think they are allergic to local anesthetic because their heart raced when they got a shot at the dentist.

 

[Apollyon]

Isnt Euflexxa the only "completely" synthetic... but i think this only applies if you are allergic to chicken...

I think if you have a problem, its gonna be hard to defend...i would avoid. but im a scaredy cat

I thought it was allergy to birds - not limited to chickens.

 

[Gauss]

extra-articular injection of any hyaluronate may generate hyper-inflammatory soft tissue reaction. Synvisc is a known culprit even intra-articular: "only the non-hyaluronan portion of the Synvisc product created an immunological response"
http://www.jbjs.org/article.aspx?Volume=89&page=148

euflexxa + some corticosteroid if you wanna be safe

 

[TX PAIN DOC]

extra-articular injection of any hyaluronate may generate hyper-inflammatory soft tissue reaction. Synvisc is a known culprit even intra-articular: "only the non-hyaluronan portion of the Synvisc product created an immunological response"
http://www.jbjs.org/article.aspx?Volume=89&page=148

euflexxa + some corticosteroid if you wanna be safe

👍 I would agree with the above. I would obtain previous medical record documenting the reaction and physical findings prior to treatment.

 

[Mister Mxyzptlk]

I just decided to not do it. Every package insert for every alternative has an allergy warning. What is the risk/benefit ratio here (for me I mean)?

 

[Jcm800]

I just decided to not do it. Every package insert for every alternative has an allergy warning. What is the risk/benefit ratio here (for me I mean)?

im with you...not a lot of reward for 2 years of lingering risk...

 

[bedrock]

im with you...not a lot of reward for 2 years of lingering risk...

Sounds like that patient is ready for a joint replacement.

And they can thank the legal community for that one.........

 

[specepic]

I am in an ortho group so we use a lot of visco. We stopped using synvisc b/c of the 1/50 risk of sterile synovitis. So did the pt have a general allergic reaction or focal redness/pain at the joint? Also, our answer for pts with a synvisc issue, whatever the cause, is euflexxa. I would have no concerns injecting this pt with Euflexxa. If one was really worried you could pre-treat just like you would for 'contrast alergy' pts but that seems over the top.

 

[Mister Mxyzptlk]

I am in an ortho group so we use a lot of visco. We stopped using synvisc b/c of the 1/50 risk of sterile synovitis. So did the pt have a general allergic reaction or focal redness/pain at the joint? Also, our answer for pts with a synvisc issue, whatever the cause, is euflexxa. I would have no concerns injecting this pt with Euflexxa. If one was really worried you could pre-treat just like you would for 'contrast alergy' pts but that seems over the top.

I don't know if the synovitis is a true reaction or if perhaps they get a synovial injection. What has decreased the incidence for me is I inject 3 ccs of lidocaine as I advance the needle to push the synovium out of the way.

I just got a note from the referring doc asking me to please please please try it, so Euflexxa it is.

 

[Doctodd]

the very rare reaction with Synvisc isnt worth using it ...... ever. The other reps make sure we know this.....Hyalgan or Supartz or Euflexxa, but the Orthos usually get these patients.

 

[hyperalgesia]

Henry Schein charges almost $1400 for Synvisc ONE. I saw on the company website how to bill for this in (units). But can anyone give me an idea how/if this is reimbursed by Medicare? It's a pretty hefty investment... TIA

 

[Ligament]

Do any of you use Orthovisc?

 

[SSdoc33]

Do any of you use Orthovisc?

yeah, i do.

i think they are all pretty much interchangeable, except for synvisc and synvisc 1, which have more problems with the aseptic reaction

 

[Mister Mxyzptlk]

Since posting this last year I've been using Euflexxa for those with Synvisc reactions. No problems at all.

 

[ampaphb]

I personally had the "pseudosepsis" reaction to Synvisc when my knee was injected. Switched practice to Supartz the following day.

 

[nvrsumr]

I had been having my patients get their synvisc thru their pharmacy benefit program but this has been less and less succesful recently.

For patients with straight medicare but no supplement if I order synvisc- J7325 will they owe me the 20% or will medicare cover the whole J code?

Any billing secrets so I dont get caught holding the bag on a $500 med?

Thanks in advance as always.

 

[hyperalgesia]

I'm thinking about asking a patient to pick up his prescribed Synvisc at Walmart Pharmacy and bring it to his appt. Anyone else do this? It's about $1k worth of med.

 

[Ducttape]

I'm thinking about asking a patient to pick up his prescribed Synvisc at Walmart Pharmacy and bring it to his appt. Anyone else do this? It's about $1k worth of med.

Didn't do for sunvisc per se but did this for qutenza a few times. One patient elected to cancel at last minute cause of expense. Sticker shock was great in all cases.

 

[mjakec]

x

 

[Mister Mxyzptlk]

I personally had the "pseudosepsis" reaction to Synvisc when my knee was injected. Switched practice to Supartz the following day.

Last year two of my patients were admitted because they went to the ER for a Synvisc reaction and were diagnosed with septic joints (even though it was only 24 hrs). One almost had her knee I&D'd. Fortunately they called an ortho consult (not me of course) who pointed out that WBC was normal and when the knee was tapped there was clear yellow fluid.

There have also been several who didn't go to the ER that I treated with IA steroids. I have used synthetic on them w/o any trouble.

Now I use synthetic stuff. It's a PITA to have to do 3 shots instead of one but there have been too many ADR's to justify Synvisc now unless they have had it before w/o problems and want it for the repeat.

 

[hyperalgesia]

Have you guys tried "Gel-One" by Zimmer? Supposed to be purified so less chance of avian reaction. Interesting they also claim the "joint residence time" in animal studies is 91 days, compared to 28 days for Synvisc-One...

 

[Mister Mxyzptlk]

Interesting to hear about "joint residence time". For some reason I was under the impression that it was gone a lot faster than that.