Low-dose SoluMatrix diclofenac in the treatment of osteoarthritis: A 1-year, open-label, Phase III safety study

Comparing Intra-articular Platelet-Rich Plasma With Hyaluronic Acid for the Treatment of Hip Osteoarthritis: A Systematic Review and Meta-Analysis

Hip osteoarthritis (HOA), a prevalent condition among those aged 55 years and above, is a significant cause of joint pain and functional impairment and it contributes to the overall burden of chronic pain experienced by the elderly population. While platelet-rich plasma (PRP) and hyaluronic acid (HA) injections have emerged as innovative therapeutic approaches for managing osteoarthritis, their effectiveness in HOA remains a subject of contention. Therefore, the objective of this review was to assess the efficacy of PRP versus HA in terms of pain relief and functional outcomes for the management of HOA. We searched PubMed, Cochrane Library, and Google Scholar databases from 2013 to 2023 to identify pertinent randomized controlled trials (RCTs). A total of seven trials (478 participants) were included. The selected studies underwent quality assessment using the updated Cochrane risk of bias tool. The pain and functional outcomes were examined using measures of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scale, visual analog scale (VAS), and Harris hip score (HHS). In the meta-analysis, standard mean differences (SMDs) along with 95% confidence intervals (CIs) to estimate overall effect magnitudes for continuous outcomes were extracted. Statistical significance was determined using p-values below 0.05. At six months, the PRP group experienced a significantly lower standard mean WOMAC pain score (SMD = -0.38, CI = -0.64 - 0.13; p = 0.03). No significant differences in WOMAC pain scores were noted at one to two months (SMD = 0.09, CI = -0.24, 0.43; p = 0.59), and at 12 months (SMD = -0.85, CI = -1.81, 0.12; p = 0.09). Similarly, for VAS, patients on PRP showed a slight improvement in their VAS scores at six months (SMD = -0.50, CI = -0.89, -0.12; p < 0.01). However, no significant differences in VAS between the PRP groups and the HA groups were observed at one to two months (SMD = -0.22, CI = -0.49, 0.04; p = 0.10) and at 12 months (SMD = -0.22, CI: -0.63, 0.19; p = 0.29). In terms of hip dysfunction, there was no statistically significant standard mean difference in HHS between the PRP and HA groups at six months (SMD = 0.02, CI = -0.40, 0.44; p = 0.93), and at 12 months (SMD = -0.31, CI = -0.32, 0.22; p = 0.73). This review and meta-analysis provide insights into emerging treatments for HOA, especially considering that PRP shows potential benefits and safety for patients with HOA during mid-term follow-up in a 12-month period. Nevertheless, it is necessary to conduct research that includes high-quality designs and larger sample sizes to validate the comparative efficacy of these treatments.

Low-Dose NSAIDs Efficacy in Orthopedic Applications

Non-steroidal anti-inflammatory drugs (NSAIDs) [cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) inhibitors] and COXIBs (the COX-2 selective inhibitors) may induce several potentially severe and life-threatening issues especially in elderly patients. The use of low-dose NSAIDs is associated with lower risk of side effects compared to the standard dosage. Low-dose NSAIDs could minimize the side effects of these drugs while maintaining their clinical efficacy and effectiveness. The present study evaluates the effectiveness and safety of low-dose NSAIDs in musculoskeletal applications.

Benefits of Applying Nanotechnologies to Hydrogels in Efficacy Tests in Osteoarthritis Models-A Systematic Review of Preclinical Studies

Osteoarthritis (OA) is a severe musculoskeletal disease with an increasing incidence in the worldwide population. Recent research has focused on the development of innovative strategies to prevent articular cartilage damage and slow down OA progression, and nanotechnologies applied to hydrogels have gained particular interest. The aim of this systematic review is to investigate the state of the art on preclinical in vitro and in vivo efficacy studies applying nanotechnologies to hydrogels in OA models to elucidate the benefits of their applications. Three databases were consulted for eligible papers. The inclusion criteria were in vitro and in vivo preclinical studies, using OA cells or OA animal models, and testing hydrogels and nanoparticles (NPs) over the last ten years. Data extraction and quality assessment were performed. Eleven papers were included. In vitro studies evidenced that NP-gels do not impact on cell viability and do not cause inflammation in OA cell phenotypes. In vivo research on rodents showed that these treatments could increase drug retention in joints, reducing inflammation and preventing articular cartilage damage. Nanotechnologies in preclinical efficacy tests are still new and require extensive studies and technical hits to determine the efficacy, safety, fate, and localization of NPs for translation into an effective therapy for OA patients.

Association between the aspartic acid D-repeat polymorphisms and osteoarthritis susceptibility: An updated systematic review and meta-analyses

OBJECTIVES

Association between the D-repeat of asporin (ASPN) gene and osteoarthritis (OA) was still inconsistent. We performed this meta-analysis to systematically assess the D-repeat polymorphisms in OA susceptibility.

METHODS

Relevant studies were enrolled by searching databases. Odd ratios (ORs) with 95% confidence intervals (95% CIs) were used for evaluating the association between ASPN gene and OA. Heterogeneity was calculated using the Q statistic, and three different subgroup analyses were performed on ethnicity, gender, and OA positions respectively. False discovery rate (FDR) was applied to regulate the multiple comparisons.

RESULTS

Twelve qualified articles involving 5190 OA patients and 5167 healthy controls were included. With D13 polymorphism, Caucasian male patients have low OA susceptibility (P = .008, PFDR = .024, OR [95% CI] = 0.83 [0.73-0.95]). As to D14 polymorphism, all male patients (P = .0004, PFDR = .001, OR [95% CI] = 1.38 [1.15-1.64]), Asian male patients (P = .01, PFDR = .01, OR [95% CI] = 1.72 [1.11-2.66]), and Caucasian male patients (P = .005, PFDR = .001, OR [95% CI] = 1.32 [1.09-1.60]) have high OA susceptibility. In the pooled-population of KOA with D14 polymorphism, overall male patients (P = .03, PFDR = .045, OR [95% CI] = 1.35 [1.02-1.78]) and Asian male patients (P = .01, PFDR = .03, OR [95% CI] = 1.72 [1.11-2.66]) have high OA risk. With D16 polymorphism, Latin America patients may have high OA risk (P = .04, PFDR = .15, OR [95% CI] = 1.43 [1.02-2.01]).

CONCLUSION

Our results suggest that D-repeat of ASPN gene is mainly associated with male patients. The D13 polymorphism plays a protective role for OA in Caucasians male individuals while D14 plays a risk factor for KOA in male patients.

Hepatotoxicity of Nonsteroidal Anti-Inflammatory Drugs: A Systematic Review of Randomized Controlled Trials

BACKGROUND

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most widely used medication in several countries, including Thailand. NSAIDs have been associated with hepatic side effects; however, the frequency of these side effects is uncertain.

AIM OF THE REVIEW

To systematically review published literature on randomized, controlled trials that assessed the risk of clinically significant hepatotoxicity associated with NSAIDs.

METHODS

Searches of bibliographic databases EMBASE, PubMed, and the Cochrane Library were conducted up to July 30, 2016, to identify randomized controlled trials of ibuprofen, naproxen, diclofenac, piroxicam, meloxicam, mefenamic acid, indomethacin, celecoxib, and etoricoxib in adults with any disease that provide information on hepatotoxicity outcomes.

RESULTS

Among the 698 studies, 18 studies met the selection criteria. However, only 8 studies regarding three NSAIDs (celecoxib, etoricoxib, and diclofenac) demonstrated clinically significant hepatotoxic evidence based on hepatotoxicity justification criteria. Of all the hepatotoxicity events found from the above-mentioned three NSAIDs, diclofenac had the highest proportion, which ranged from 0.015 to 4.3 (×10^-2), followed by celecoxib, which ranged from 0.13 to 0.38 (×10^-2), and etoricoxib, which ranged from 0.005 to 0.930 (×10^-2).

CONCLUSION

Diclofenac had higher rates of hepatotoxic evidence compared to other NSAIDs. Hepatotoxic evidence is mostly demonstrated as aminotransferase elevation, while liver-related hospitalization or discontinuation was very low.

Lowering side effects of NSAID usage in osteoarthritis: recent attempts at minimizing dosage

INTRODUCTION

Osteoarthritis is a burdensome disease that causes progressive damage to articular cartilage. Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the preferred treatments for symptomatic relief. However, NSAIDs can cause serious dose-dependent side effects, which has prompted experts to recommend the minimization of NSAID dosage.

AREAS COVERED

This review focuses on three broad strategies that are currently being investigated or implemented to minimize NSAID dosage: nano-formulation, encapsulation, and topical delivery. The benefits, challenges and current status of these methods are discussed.

EXPERT OPINION

Multiple strategies are under investigation to lower NSAID dosage. There is great potential in developing formulations that utilize more than one of these strategies together. However, there are challenges to developing these lower dose preparations. In order to maximize the clinical potential of the abundance of NSAIDs that are both available and being developed, there is a major need for additional clinical studies directly comparing safety and efficacy of different preparations.

Low-dose SoluMatrix diclofenac in patients with osteoarthritis pain: impact on quality of life in a controlled trial

Low-dose SoluMatrix diclofenac was developed to provide effective pain relief for osteoarthritis pain. We evaluated the effects of SoluMatrix diclofenac on health-related quality of life (HRQoL) measures in patients with osteoarthritis, hypothesizing that SoluMatrix-treated patients would experience significant improvement compared with placebo. In this 12-week, phase 3 randomized controlled trial, 305 patients with osteoarthritis of the hip or knee received SoluMatrix diclofenac 35 mg three times (TID) or twice (BID) daily or placebo. Measures included HRQoL, assessed by Short Form 36 (SF-36, version 2), and pain, stiffness, and physical function, assessed by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline and at week 12. Descriptive statistics were calculated for mean changes from baseline; inferential statistics compared treatment groups with placebo. SoluMatrix diclofenac 35 mg BID (6.2 [0.75]; P = 0.0048) or TID (6.6 [0.80]; P = 0.0014) produced large improvements in the SF-36 physical component summary (PCS) scores at week 12 (least squares mean change from baseline [SE]) compared with placebo (3.5 [0.78]). Minimum clinically important differences were observed in six out of eight SF-36 domains among patients in SoluMatrix diclofenac groups and five out of eight domains in the placebo group; treatment with SoluMatrix diclofenac 35 mg TID produced significant improvements (P ≤ 0.03) in five out of eight domains versus placebo. SoluMatrix diclofenac 35 mg TID significantly improved responses to 23 out of 24 questions in the WOMAC versus placebo (P ≤ 0.0334). Low-dose SoluMatrix diclofenac 35 mg TID and BID significantly improved HRQoL, pain, stiffness, and physical function in patients with osteoarthritis of the hip or knee.

Repositioning Bevacizumab: A Promising Therapeutic Strategy for Cartilage Regeneration

Drug discovery and development has been garnering an increasing trend of research due to the growing incidence of the diverse types of diseases. Recently, drug repositioning, also known as drug repurposing, has been emerging parallel to cancer and tissue engineering studies. Drug repositioning involves the application of currently approved or even abandoned drugs as alternative treatments to other diseases or as biomaterials in other fields including cell therapy and tissue engineering. In this review, the advancement of the antiangiogenesis drugs that were used as treatment for cancer and other diseases, with particular focus on bevacizumab, will be described. This will include an overview of the nature and progression of osteoarthritis (OA), one of the leading global degenerative diseases that cause morbidity, and the development of its therapeutic strategies. In addition, this will also feature the nonsteroidal anti-inflammatory drugs that are commonly prescribed for OA and the benefits of repositioning bevacizumab as alternative treatments for other diseases and as biomaterials for cartilage regeneration. To date, a few number of studies, employing different modes of administration and varying dosages in diverse animal models, have shown that bevacizumab can be used as a signal and can promote both in vitro and in vivo cartilage regeneration. However, other antiangiogenesis drugs and their effects in chondrogenesis and cartilage regeneration are also worth investigating.