May 19, 2020

Dr. Drew Lansdown Platelet Rich Plasma (PRP) Interview

Dr. Drew Lansdown Platelet Rich Plasma (PRP) Interview

Dr. Drew Lansdown Platelet Rich Plasma (PRP) Interview
Dr. Drew Lansdown UCSF giving a talk on platelet rich plasma (PRP). Screenshot.

Platelet Rich Plasma (PRP) has been around for a long time, but patients are often confused by it. In part the confusion arises from how it is marketed, which sometimes includes it being described as “stem cells”, which it is not. However, at times it can be as a therapy with stem cells or other biologics, which also adds to the complexity.

Dr. Drew Lansdown Platelet Rich Plasma (PRP) Interview
Dr. Drew Lansdown UCSF giving a talk on platelet rich plasma (PRP). Screenshot.

To help clarify where things stand including on the clinical science, I’m going to do a series of new posts on platelet rich plasma.

We start the series today with an interview with an expert on it, Dr. Drew Lansdown of UCSF. I also highly recommend a YouTube video of Lansdown giving a talk on platelet rich plasma, which I’ve pasted at the bottom of the post.

Note that I have a new series of polling on stem cell and related treatment coasts including for PRP so please participate if you’ve had PRP therapy.

Here’s the interview with Dr. Lansdown.

What are the main types of platelet rich plasma and what makes them different? Which type do you use and why?

DL: There are a few different ways that PRP can be classified. One way is based on the presence of leukocytes, or white blood cells. This grouping divides PRP into leukocyte-rich and leukocyte-poor PRP. Removing the leukocytes takes an extra step in preparation. The presence of leukocytes may produce more of an inflammatory response in the early period after the injection. The other way to classify PRP is based on the presence or absence of fibrin. Fibrin leads to activation of PRP, which produces a more gel-like consistency. This form may be more appropriate for direct applications in surgical treatment. Leukocyte-poor PRP is generally favored for joint injections, while leukocyte-rich PRP may be used in tennis elbow (lateral epicondylitis).

Dr. Drew Lansdown Platelet Rich Plasma (PRP) Interview
PRP (Platelet Rich Plasma) being injected into a hand. Wikimedia Creative Commons open source image credited to Alice Pien, MD.

What do you think is the type of medical condition that has the most compelling data in favor of PRP use over more traditional approaches/standard of care? 

DL: I think we still need more data to really establish if PRP should be used over traditional approaches or could be considered standard of care, and at this point, I would favor considering PRP at times if traditional treatment options are not proving sufficient. The conditions that currently have the best evidence to support the use of PRP are early mild-to-moderate knee osteoarthritis and lateral epicondylitis (tennis elbow). There are multiple randomized controlled trials demonstrating effectiveness for both of these conditions, though there are trials for both that also show no or a more limited effect of PRP. I think this highlights the need for further research to define which patients will respond and where these injections may play a role for treatment.

Are there conditions for which you wouldn’t advise PRP use at this time based on the data?

DL: I do not think we have enough evidence at this time to support the use of PRP in the shoulder, for either rotator cuff injuries or shoulder arthritis. Other tendon conditions, like Achilles tendinitis, also do not have enough data to routinely support their use.

How long does the benefit of PRP last?

DL: It seems from the studies that we have that results may last for about 1 year. This expected duration of benefit though does need to be clarified.

I saw your Bendich, et al. paper on PRP cost for knee OA. You concluded, “For patients with symptomatic knee osteoarthritis, PRP is cost-effective, from the payer perspective, at a total price (inclusive of clinic visits, the procedure, and the injectable) of less than $1,192.08 over a 12-month period, relative to HA and saline solution.” You also wrote, “cost would have to be less than $3,703.03” for a 6-month period. How do these numbers compare to what patients are actually paying and how often are they getting PRP?

DL: The difference in the 6 month and 12 month costs are a potentially confusing part about this paper. In the published trials that we used for this study, saline actually had more of an improvement than hyaluronic acid at 6 months after injection, while the reverse was true at 12 months. This happened because we included different trials that reported results at different time points. For this reason, the PRP cost at 6 months (relative to the cost of saline, which is inexpensive) was actually higher than the 12 month cost (relative to HA, which is more expensive).

Patients are often paying more than this amount, which is important to note includes the cost of the clinic visit, and injection procedure. Patients may be charged up to $2000 or even more for an injection. Some patients will receive recommendations for multiple injections as well, which further drives up the cost to the patient.

In a nutshell, are most patients having a cost-effective experience?

DL: I think that many patients are not having a cost-effective experience with PRP. Since these injections are rarely covered by health insurance and are paid for directly by the patients, there is no real standardization for the amount charged for the injections as there is for other medications/treatments. That was part of the motivation for this study, to try and provide some relative cost based on other treatments that are commonly used for knee osteoarthritis.

What’s your view of direct-to-consumer clinics selling PRP? Does it vary by the specific clinic/brand in terms of whether it’s wise for patients to go that route?

DL: I think that some of the direct advertising can be misleading to patients as to the actual potential effects of PRP. Some of the advertisements suggest that PRP can be a cure-all and may convince patients to spend large amounts of money on a treatment that may not be beneficial for them. I think it is important for patients to understand that, while there is much excitement about PRP, there is still much that we do not know.

Note from The Niche that this post is not meant as medical advice. Talk to your doctor before making any medical decisions, including about platelet rich plasma.

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