Pharmacotherapy for knee osteoarthritis: current and emerging therapies

ABSTRACT

Introduction

Osteoarthritis (OA) is the leading cause of pain, loss of function and disability in the elderly, with the knee being the most impactful joint affected. Currently, there is still no ‘cure’ in OA treatment.

Areas covered

The authors review the current and emerging therapies for knee OA including traditional OA medications (oral and topical NSAIDs, acetaminophen, and opioids) and emerging treatments including disease-modifying OA drugs. The failures of agents that have been through clinical trials are also summarized. Furthermore, the authors provide their expert perspectives on the future of pharmacotherapy for knee osteoarthritis.

Expert opinion

Compared to traditional OA medications, new disease-modifying OA drugs that act by reducing inflammation and increasing cartilage repair show promise to address the unmet need of disease modification. Many of these new drugs, however, are in the preclinical stage. Long-term RCTs are expected to identify the safety and efficacy of novel OA pharmacotherapy medicines.

KEYWORDS:

• Osteoarthritis
• disease modification
• pain
• pharmacotherapy

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Declaration of Interest

DJ Hunter provides consultancy support for Pfizer Inc, Eli Lilly and Company, TLCBio and Merck Serono. The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Article highlights

• Most guidelines are consistent in advocating for non-pharmacologic treatments as the core of initial interventions including exercise, weight loss and education.

• Traditional pharmacological interventions have focused on symptom management and the most widely used agents include oral and topical non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and opioids.

• Pain is the dominant symptom of OA, is still an unmet need and recent years have witnessed several prominent clinical trials for OA pain, and among those, trials with antibodies that neutralize nerve growth factor (NGF) appear particularly promising.

• A drug that inhibits the structural disease progression of OA with symptomatic relief, is defined as a disease-modifying osteoarthritis drug (DMOAD). A number of promising agents are being developed in this area.

• Numerous agents have been tested and developed for purported DMOAD activity and failed-important lessons have been learned which had been applied in more recent trials.

Additional information

Funding

This manuscript has not been funded.