Johns Hopkins Health Alert
In the Pipeline: DMOADs for Osteoarthritis
Wouldn't it be wonderful if there were a drug that could stop -- or at least slow -- the damage that osteoarthritis (OA) can inflict on your joints? This ideal medication would actually change the course of osteoarthritis, not just treat the symptoms.
Such a treatment is available for rheumatoid arthritis (RA): Disease-modifying antirheumatic drugs, or DMARDs, actually slow down the disease process and limit joint damage in many people with rheumatoid arthritis. And in recent years, several of these drugs have been approved by the U.S. Food and Drug Administration (FDA).
By comparison, the development of similar disease-modifying osteoarthritis drugs (DMOADs) has been slow, and not one DMOAD has been approved by the FDA. But that could change -- if the FDA changes the way it judges whether a drug has had an effect on osteoarthritis progression.
The Wrong Yardstick? Joint space narrowing (a sign of cartilage loss) at the knee or hip indicates worsening osteoarthritis. Since 1999, the primary yardstick the FDA has used to measure the success of an osteoarthritis drug is that it must stop, reverse or at least slow joint space narrowing as shown on X-rays. In addition, the medication must effectively relieve the pain caused by osteoarthritis. But researchers claim this approach is problematic on several levels.
- First, studies using MRI show that damage to the meniscus (tissue between the cartilage surfaces that distributes weight and improves joint stability) also contributes to joint space narrowing. What's more, these changes cannot be seen on x-rays.
- In addition, many of the new DMOADs under development don't target cartilage. Instead, they attempt to modify molecular pathways responsible for tissue destruction in other joint tissues, such as bone, synovium, ligaments and the meniscus. Changes in these tissues may occur before the cartilage begins to deteriorate. And a drug that may have a beneficial effect on one of these disease-modifying pathways may not result in joint space improvement on X-rays, especially in the short term.
- Another concern: A person could have cartilage damage but not feel any pain since there are no nerves or blood vessels in it. Consequently, pain relief may not always be an important indicator of a drug's effectiveness at stopping or slowing disease progression.
In Search of a New Paradigm. The good news is that the FDA has asked for input from researchers, the pharmaceutical industry and patient advocacy groups regarding better ways to evaluate the efficacy of DMOADs being considered for approval by the agency. Known as the OARSI (Osteoarthritis Research Society International)-FDA Initiative, the major goals of the effort are to re-examine the 1999 definition of osteoarthritis progression and determine the best ways to evaluate new drugs for prevention and treatment of osteoarthritis.
Posted in Arthritis on September 12, 2011
Medical Disclaimer: This information is not intended to substitute for the advice of a physician. Click here for additional information: Johns Hopkins Health Alerts Disclaimer
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Alternative medicine has been treating arthritis successfully for many years. All the substances are natural, they all work, there are no side effects, and you don't need a prescription or a doctor's visit. A doctor wouldn't prescribe it anyway because it is not recommended by detail men.
Posted by: allmymarbles | September 17, 2011 11:18 AM