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Osteoarthritis Cartilage ; 30(2): 196-206, 2022 02.
Article in English | MEDLINE | ID: covidwho-1474752


This "Year in review" presents a selection of research themes and individual studies from the clinical osteoarthritis (OA) field (epidemiology and therapy) and includes noteworthy descriptive, analytical-observational, and intervention studies. The electronic database search for the review was conducted in Medline, Embase and medRxiv (15th April 2020 to 1st April 2021). Following study screening, the following OA-related themes emerged: COVID-19; disease burden; occupational risk; prediction models; cartilage loss and pain; stem cell treatments; novel pharmacotherapy trials; therapy for less well researched OA phenotypes; benefits and challenges of Individual Participant Data (IPD) meta-analyses; patient choice-balancing benefits and harms; OA and comorbidity; and inequalities in OA. Headline study findings included: a longitudinal cohort study demonstrating no evidence for a harmful effect of non-steroidal anti-inflammatory drugs (NSAIDs) in terms of COVID-19 related deaths; a Global Burden of Disease study reporting a 102% increase in crude incidence rate of OA in 2017 compared to 1990; a longitudinal study reporting cartilage thickness loss was associated with only a very small degree of worsening in pain over 2 years; an exploratory analysis of a non-OA randomised controlled trial (RCT) finding reduced risk of total joint replacement with an Interleukin -1ß inhibitor (canakinumab); a significant relationship between cumulative disadvantage and clinical outcomes of pain and depression mediated by perceived discrimination in a secondary analysis from a RCT; worsening socioeconomic circumstances were associated with future arthritis diagnosis in an innovative natural experiment (with implications for unique research possibilities arising from the COVID-19 pandemic context).

Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , COVID-19/epidemiology , Disease Management , Osteoarthritis/epidemiology , Comorbidity , Global Health , Humans , Incidence , Osteoarthritis/drug therapy
Osteoarthritis and Cartilage ; 29:S264, 2021.
Article in English | EMBASE | ID: covidwho-1222948


Purpose: To date, no disease-modifying osteoarthritis drugs (DMOADs) have been approved for the treatment of knee osteoarthritis (OA). S201086/GLPG1972 is a potent and selective inhibitor of ADAMTS-5 (a disintegrin and metalloproteinase with thrombospondin motif-5) in development as a DMOAD, hypothesized to reduce cartilage loss via inhibition of the enzymatic cleavage of aggrecan (a key component of cartilage). S201086/GLPG1972 has been shown to reduce cartilage degradation in preclinical models of OA. Therefore, we aimed to evaluate the efficacy and safety of S201086/GLPG1972 in patients with knee OA. Methods: ROCCELLA was a randomized, placebo-controlled, dose-ranging, phase 2 study comprising a 5-week screening period, a 52-week double-blind treatment period and a 2-week safety follow-up period ( ID: ). Patients aged 40-75 years with knee OA and pain severity in the target knee of 40-90 mm on a visual analog scale at screening and baseline were included. Target knees had predominant medial compartment disease, with Kellgren-Lawrence (KL) grade 2 or 3 and OARSI medial joint space narrowing (JSN) grade 1 or 2. Patients were randomized 1:1:1:1 to placebo or 75 mg, 150 mg or 300 mg S201086/GLPG1972 administered orally once daily. Concomitant analgesics (non-steroidal anti-inflammatory drugs and acetaminophen) were permitted. The primary endpoint was change from baseline to week 52 in cartilage thickness of the central medial femorotibial compartment (cMFTC) of the target knee, as measured by quantitative magnetic resonance imaging (qMRI) and analyzed by a central reading facility. Secondary efficacy endpoints included: change from baseline to week 52 in radiographic joint space width of the target knee (JSW;X-ray with central readout);patient-reported outcomes (including WOMAC scores, patient global assessment [PGA] score and pain score, both measured by visual analog scales);and safety outcomes. A mixed-effects model for repeated measures (using all longitudinal observations at each post-baseline visit) was used for the primary analysis. Results: Across 12 countries, 3319 patients were screened and 932 were included in the study. Patients had a mean age of 62.9 years and the majority (69.3%) were women. Baseline characteristics were similar across study groups (Table 1). Overall, 88.8% of knees were KL grade 3 and 67.3% were OARSI medial JSN grade 2. Patients experienced substantial cartilage loss;the mean (SD) change in cMFTC cartilage thickness was −0.12 (0.27) mm from baseline to week 52 in the placebo group. However, no statistically significant differences between treatment groups and placebo were observed for the primary endpoint of cMFTC cartilage thickness loss (placebo vs 75 mg, p = 0.165;vs 150 mg, p = 0.939;vs 300 mg, p = 0.682;Figure 1). These results were confirmed by sensitivity analyses assessing the management of missing data and delayed week 52 qMRI owing to the COVID-19 pandemic. No significant differences between treatment groups and the placebo group were observed at any time point in any of the secondary endpoints, including changes in WOMAC total score and subscores (Figure 2), radiographic JSW, PGA score or pain score. Treatment-emergent adverse events (TEAEs) and serious adverse events were experienced by similar proportions of patients in the placebo and S201086/GLPG1972 groups (Table 2). The most common TEAEs across all S201086/GLPG1972 treatment groups were arthralgia, nasopharyngitis and fall (Table 2). Tolerability was similar across the three S201086/GLPG1972 dose groups, with 6.8% (75 mg) to 8.6% (300 mg) of patients withdrawing from treatment owing to TEAEs, compared with 3.8% in the placebo group. Conclusions: The study successfully selected patients who experienced a substantial decrease in cartilage thickness over 52 weeks;a decrease that would be large enough to demonstrate a sizeable structural benefit of a DMOAD candidate. However, the study failed to meet its primary endpoint (change from baseline to week 52 in cartilage thickness of the cMFTC) and secondary endpoints, and there was no dose-response relationship. S201086/GLPG1972 had a good safety profile and was generally well tolerated. [Formula presented] [Formula presented] [Formula presented] [Formula presented]