My Choices From ACR2014: Best Reports About Osteoarthritis

Selected brief summary of presentations on therapy of osteoarthritis (OA):

1) Non-Pharmacologic

There was prolonged improvement in pain with gastric bypass, more than with gastric banding bariatric surgery. Pain reduction was proportionate to weight loss and not related to radiographic disease severity.

Andrea Leyton-Mange, Janice Lin, Ryan Flanagan et al. Reduction of Knee Osteoarthritis Symptoms in a Cohort of Bariatric Surgery Patients. Abstract #2246

2)Pain

AF-219 was superior to placebo for knee OA in a 4-week study.  AF-219 is an antagonist of P2X3, a receptor that mediates ATP released from inflamed and damaged primary afferent neurons.

Vibeke Strand, Michael Kitt, Alan Kivitz, et al.An Exploratory 4-Week Study of a P2X3 Antagonist AF-219 in the Treatment of Patients with Osteoarthritis (OA) of the Knee. Abstract #2240

3) Topical

Addition of a “permeability enhancer” to topical diclofenac increased absorption therefold with prolonged exposure;

Giuseppa Quartarone and Nathalie Hasler-Nguye.  Comparison Between Two Diclofenac Diethylamine Gel Formulations, 1.16% Vs 2.32%: Is It Only Increasing the Strength of the Active Ingredient Enough? Abstract #2243

4) Intraarticular (IA)

An intra-articular (IA) biolubricant, MM-II, had a more rapid onset of benefit than and was equal to IA hyaluronate in a 3-month study; 

Leonid Kandel, Yaniv Dolev, Rachel Shimonov, et al.  Safety and Efficacy of Liposome Intra-Articular Injection in Moderate Knee Osteoarthritis. A Prospective Randomized Double-Blinded Study. Abstract #2234
 

5) NSAIDs

Reduced doses of diclofenac (35 mg up to tid) provided prolonged (12 month) pain relief by use of Solumatrix fine-particle technology;

Vibeke Strand, Allan Gibofsky, Marc Hochberg

et al.

A Phase 3 Open-Label Trial of Low-Dose Solumatrix Diclofenac in Patients with Osteoarthritis Pain: Impact of Long-Term Administration on Patient-Reported Outcomes

. Abstract #249
 

6) Supplements

From the Osteoarthritis Initiative, compared to NSAIDs glucosamine/chondroitin sulfate demonstrated less progression of cartilage loss by qMRI with/without meniscal extrusion.

Jean-Pierre Pelletier, Camille Roubille, François Abram et al. The Effects of Treatment on Disease Symptoms and Progression of Structural Changes in Knee Osteoarthritis Participants from the Osteoarthritis Initiative Progression Cohort. Abstract #2250
 

7) Surgical

Narrower retinal arteriolar caliber was associated with an increased risk of knee replacement, suggesting a role for microvascular disease in OA.

Sultana Monira Hussain, Yuanyuan Wang, Jonathan E Shaw et al. Retinal Arteriolar Narrowing and Incidence of Knee Replacement for Osteoarthritis: A Prospective Cohort Study. Abstract #1277
 

8) Negative trials

Apremilast was not clinically effective in hand OA.

Juergen Rech, Francesca Faustini, Axel J. Hueber, et al. A PHASE 2, Multicenter, Randomized, Double-Blind, Placebo-Controlled, Parallel-Group, Efficacy Study of Apremilast (CC-10004) in Subjects with Erosive Hand Osteoarthritis. Abstract #2233

A preparation of oral calcitonin was not effective in 2 clinical trials.

Morten Asser Karsdal, Anne C. Bay-Jensen, Asger Bihlet et al. Treatment of Symptomatic Knee Osteoarthritis with Oral Salmon Calcitonin: Results from Two Phase 3 Randomized Clinical Trials. Abstract #2230