Bruyere_edit.qxp 1/10/07 12:22 Page 30
Osteoarthritis
reduction in the proportion of patients with a worse osteophyte progressors (JSN >0.5mm) were 17.7, 18.9 and 20.3% (p=0.90) in
score at the end-point (20% in the placebo versus 6% in the GS groups 1, 2 and 3, respectively.
group; p=0.03).
Risedronate
Intra-articular Hyaluronic Acid The efficacy and safety of risedronate in patients with knee OA was
Hyaluronate was evaluated in a one-year randomised controlled pilot assessed in the British study of Risedronate In Structure and symptoms
study in patients with knee OA evaluated by arthroscopy.
10
Of the of Knee OA (BRISK).
13
BRISK was a one-year, prospective, double-blind,
39 included patients, 36 were evaluated after one year. Hyaluronate placebo-controlled study. Patients were randomised to once-daily
was injected into the joint once a week for three weeks, at intervals of risedronate 5 or 15mg or placebo. Radiographs were taken at baseline
three months. Lesion severity was evaluated using the score developed
by the French Society for Arthroscopy. After one year, the score was
significantly lower in the treated group than in the control group
(p=0.05). However, no significant difference was found for JSW
Several compounds have shown small
measured on radiographs.
to moderate structural efficacy in
Hyaluronate has also been evaluated versus a placebo in 319 patients osteoarthritis.
with knee OA. JSW was measured on conventional extended-knee
radiographs. After one year, no significant difference was found
between the two treatment groups. However, in the subgroup of
patients whose JSW was >4.6mm at baseline, joint-space loss was and one year for assessment of JSW using a standardised radiographic
reduced in the hyaluronate group compared with the placebo method with fluoroscopic positioning of the joint. Overall, the
group (p=0.02).
11
difference between treatment groups in terms of loss of JSW at 12
months was not statistically significant (p=0.275). A post hoc analysis
of the distribution of change from baseline values in JSW at one year
…in the subgroup of patients whose
showed a greater presence of detectable progression (i.e. loss of JSW
≥25% or ≥0.75mm) in the placebo (8%) and risedronate 5mg (4%;
joint-space width was >4.6mm at
p=0.36) groups than in the risedronate 15mg group (1%; p=0.067).
baseline, joint-space loss was reduced The results of a two-year multicentre international study of risedronate
in knee OA, presented in an international meeting,
14
found no drug
in the hyaluronate group compared
effect at a dose of 5 or 15mg on JSW changes compared with placebo.
with the placebo group (p=0.02).
Conclusion
Several compounds have shown small to moderate structural efficacy
Another study aimed to evaluate the long-term efficacy of three in OA. So far, the most compelling evidence of potential for inhibiting
iterative courses of three weekly intra-articular (IA) injections of the the progression of OA is obtained with GS, while some research also
hyaluronic acid (HA) compound NRD101 in the treatment of suggests that ASU, CS, diacerein or doxycycline could be used in the
symptomatic knee OA.
12
In this placebo-controlled study of 301 same indication. The structure-modifying effects of other compounds
patients aged over 50 years with painful and radiological medial knee (i.e. alendronate, strontium ranelate, calcitonin, zoledronate and
OA, patients were randomly assigned into three groups: group 1 selective oestrogen receptor modulator) are supported by pre-clinical
received IA injections of HA and oral placebo; group 2 received IA data and should be investigated for this specific purpose. It should be
injections of saline solution and diacerein 100mg/day; and group 3 borne in mind that all conclusive results were obtained with
received IA injections of saline solution and oral placebo. After one prescription drugs containing these substances and should not be
year of follow-up, JSW deteriorated (-0.09mm; n=277; p=0.01), but extrapolated to over-the-counter or food supplements, whose content,
with no difference between the groups (p=0.82). Percentages of pharmacokinetics and pharmacodynamics are not guaranteed. ■
1. Lequesne M, Maheu E, Cadet C, Dreiser RL, Structural effect of 6. Brandt KD, Mazzuca SA, Katz BP, et al., Effects of doxycycline 153–60.
avocado/soybean unsaponifiables on joint space loss in on progression of osteoarthritis: results of a randomized, 11. Jubb RW, Piva S, Beinat L, et al., A one-year, randomised,
osteoarthritis of the hip, Arthritis Rheum, 2002;47:50–58. placebo-controlled, double-blind trial, Arthritis Rheum, 2005;52: placebo (saline) controlled clinical trial of 500–730 kDa sodium
2. Uebelhart D, Thonar EJ, Delmas PD, et al., Effects of oral 2015–25. hyaluronate (Hyalgan) on the radiological change in
chondroitin sulfate on the progression of knee osteoarthritis: a 7. Reginster JY, Deroisy R, Rovati LC, et al., Long-term effects of osteoarthritis of the knee, Int J Clin Pract, 2003;57:467–74.
pilot study, Osteoarthritis Cartilage, 1998;6(Suppl. A):39–46. glucosamine sulphate on osteoarthritis progression: a 12. Pham T, Le Henanff A, Ravaud P, et al., Evaluation of the
3. Uebelhart D, Malaise M, Marcolongo R, et al.,Intermittent randomised, placebo-controlled clinical trial, Lancet, 2001;357: symptomatic and structural efficacy of a new hyaluronic acid
treatment of knee osteoarthritis with oral chondroitin sulfate: a 251–6. compound, NRD101, in comparison with diacerein and placebo
one-year, randomized, double-blind, multicenter study versus 8. Altman RD, Abadie E, Avouac B, et al., Total joint replacement in a 1 year randomised controlled study in symptomatic knee
placebo, Osteoarthritis Cartilage, 2004;12:269–76. of hip or knee as an outcome measure for structure modifying osteoarthritis, Ann Rheum Dis, 2004;63:1611–17.
4. Michel BA, Stucki G, Frey D, et al., Chondroitins 4 and 6 sulfate trials in osteoarthritis, Osteoarthritis Cartilage, 2005;13:13–19. 13. Spector TD, Conaghan PG, Buckland-Wright JC, et al., Effect of
in osteoarthritis of the knee: a randomized, controlled trial, 9. Pavelka K, Gatterova J, Olejarova M, et al., Glucosamine sulfate risedronate on joint structure and symptoms of knee
Arthritis Rheum, 2005;52:779–86. use and delay of progression of knee osteoarthritis: a 3-year, osteoarthritis: results of the BRISK randomized, controlled trial
5. Dougados M, Nguyen M, Berdah L, et al., Evaluation of the randomized, placebo-controlled, double-blind study, Arch Intern [ISRCTN01928173], Arthritis Res Ther, 2005;7:R625–33.
structure-modifying effects of diacerein in hip osteoarthritis: Med, 2002;162:2113–23. 14. Bingham C, Beary JF, Cohen S, et al., Clinically significant
ECHODIAH, a three-year, placebo-controlled trial. Evaluation of 10. Listrat V, Ayral X, Patarnello F, et al., Arthroscopic evaluation of placebo improvement occurs by 6 months and is maintained
the Chondromodulating Effect of Diacerein in OA of the Hip, potential structure modifying activity of hyaluronan (Hyalgan) in through 24 months in a study of knee OA and function,
Arthritis Rheum, 2001;44:2539–47. osteoarthritis of the knee, Osteoarthritis Cartilage, 1997;5: Arthritis Rheum, 2004;50:S149.
30 EUROPEAN MUSCULOSKELETAL REVIEW 2007
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99