New developments in osteoarthritis pharmacological therapies

OA is an increasingly common, painful condition with complex aetiology and limited therapies. Approaches to expanding our therapeutic armamentarium have included repurposing existing therapies used for other rheumatological conditions, modifying existing OA preparations to enhance their benefits, and identifying new therapeutics. HCQ and low-dose MTX have been unsuccessful in improving hand OA pain or reducing structural progression. Anti-IL-6 and anti-GM-CSF also did not improve symptoms in hand OA trials, but IL-1 remains an intriguing target for large-joint OA, based on reduced joint replacements in a post hoc analysis from a large cardiovascular disease trial. The peripheral nociceptive pathway appears an attractive target, with mAbs to nerve growth factor and IA capsaicin demonstrating efficacy; tropomyosin receptor kinase A inhibitors are at an earlier stage of development. Limited evidence suggests pharmacological therapies can modify cartilage and bone structural progression, though evidence of synchronous symptom benefits are lacking.

Automated summary

OA is a common and painful condition with limited therapies, leading researchers to explore new treatment methods and modify existing ones. While drugs like HCQ, MTX, anti-IL-6 have not shown significant improvements for hand OA, IL-1 remains a promising target for large-joint OA. Targeting the peripheral nociceptive pathway and nerve growth factor have shown efficacy, with ongoing development of new inhibitors. Limited evidence suggests pharmacological therapies may modify structural progression, but more research is needed for symptom benefits.