here’s a recent headline that i found confusing: ‘d the 1st drug that slos arthritis be here?
it’s confusing cause it depends on which of the + than 100 types of arthritis we’re discussing. we’ve had drugs that slo rheumatoid arthritis for decades. in fact, + than a dozen fda-approved drugs can reduce, or even halt, joint damage in pplz with rheumatoid arthritis. wolso' ‘ve effective drations to slo or stop gout, another common type of arthritis.
but'a headline refers to osteoarthritis, the most common type of arthritis. and currently, no drations can safely and reliably slo the pace of this worsening joint disease. that’s one reason so many knee and hip replacements are performed: + than 1.2 million each yr inna us alone.
a drug that can slo down joint degeneration in osteoarthritis has long bind'a holy grail of arthritis treatments, cause it ‘d
- relieve pain and lessen sufferation for millions of pplz
- help prevent the loss of function that accompanies osteoarthritis
- reduce the need for surgery, along with its attendant risks, expense, and time needed for recovery.
and, needless to say, such a drug ‘d generate enormous profits for the pharmaceutical company that comes up with it 1st.
a study of ♥ disease mite ‘ve identified a new treatment for osteoarthritis
according to new research published in annals of internal med, it’s possible that such a treatment exists, and is already in use to treat other conditions. the researchers reanalyzed data on + than 10,000 pplz that originally looked at whether the drug canakinumab was beneficial for pplz witha previous ♥ attack — yes, ♥ attack, not arthritis.
canakinumab inhibits interleukin-1, a substance closely involved with inflammation. and increasing evidence suggests that inflammation rezs risk for cardiovascular disease, and may predict future cardiovascular trouble. all study pticipants had previously had a ♥ attack. additionally, they had an elevated blood c-reactive protein (crp) lvl, an indicator of inflammation in d'body.
every 3 mnths, each person received an injection of one of several doses of either canakinumab or a placebo. canakinumab appeared t'work for ♥ disease: those receiving the 150-mg dose of canakinumab had significantly fewer cardiovascular complications (repeat ♥ attack, stroke, or cardiovascular death) over bout 4 yrs. unfortunately, there was also a higher rate of fatal infections inna canakinumab-treated subjects.
another look at this study of canakinumab
the reanalysis compares rates of hip or knee replacement due to osteoarthritis in those receiving canakinumab with rates among those who received a placebo. the study authors thought that since canakinumab reduces inflammation, it mite help the inflammation found inna joints of pplz with osteoarthritis while also offering cardiovascular benefits.
osteoarthritis has long been pondered a wear-and-tear, age-rel8d, and non-inflammatory form of joint disease. but ‘oer the last decade or so, research has demonstrated that some degree of inflammation occurs in osteoarthritis. so it’s not too much offa stretch to think a drug like canakinumab mite be effective for osteoarthritis. this drug is already approved for a № of inflammatory conditions, including certain forms of pediatric arthritis.
the results of this new study surprised me: over bout 4 yrs, those receiving canakinumab were at least 40% less likely to ‘ve a hip or knee replacement than those receiving placebo.
warning: these results are preliminary
b4 declaring victory over osteoarthritis with canakinumab treatment, it’s primordial to ack that this trial doesn’t prove it actually works. that’s cause the trial
- was not a treatment trial of pplz with osteoarthritis. + than 80% of pticipants had no history of osteoarthritis.
- did not compare x-rays or other imaging tests b4 and after treatment to confirm the diagnosis of osteoarthritis, or demonstrate that treatment sloed its progression
- did not assess whether joint pain was present b4 treatment or improved after treatment. it’s possible that the reason there were fewer joint replacements among pplz taking canakinumab s'dat the dration reduced pain, rather than sloing joint damage. perhaps the dration can delay the need for joint replacement by reducing symptoms without sloing progression of joint damage.
- lasted bout 4 yrs. the results ‘d ‘ve been ≠ if it had lasted longer.
- 1-ly included pplz who had prior ♥ attack and an elevated crp. the results may not apply to pplz who ‘ve no history of cardiovascular problems or a normal crp.
to learn whether canakinumab actually can slo osteoarthritis, we need a proper trial that enrolls pplz with osteoarthritis, and compares symptoms and x-rays after treatment with canakinumab or placebo.
canakinumab is expensive, nearly $70,000/yr (though discounts, insurance coverage, and copays vary), and 1-ly available by injection. it’s not clear how many pplz with osteoarthritis ‘d accept such treatment. if tis proven highly effective at preventing the need for joint replacement surgery, its high cost mite be easier to accept.
the bottom line
we need definitive information bout the potential of canakinumab or rel8d drugs to treat osteoarthritis and slo its progression. til then, it’s unlikely to become a common option.
if you ‘ve osteoarthritis of the knees or hips, talk to yr dr bout yr options, including maintaining a heathy w8, staying active, and taking pain relievers as needed. some pplz improve with walking aids (s'as a cane) or knee braces (for knee arthritis). joint replacement surgery can be pondered as a last resort.
as for new treatments that can slo the progression of osteoarthritis, we ‘d be hopeful. b'we’re not there yet.
follo me on twitter @robshmerling
original content at: www.health.harvard.edu…
authors: robert h. shmerling, md