New Developments in Clinical Trials for Osteoarthritis: Are We Closer to Improving Pain Management and Disease Modification?

Abstract

Osteoarthritis (OA) is a chronic condition that can lead to pain, disability, and loss of function. There are currently few pharmacological treatments, and none are disease modifying. It is important to identify new treatments to reduce associated morbidity, as well as high costs to the individual and society. OA pathogenesis involves the cartilage, synovium, and bone, with many mediators in the immune system implicated in this process. These provide several targets for pharmacotherapy that can be divided into treatments that target pain or disease-modifying drugs that aim to maintain the joint. Previous OA trials conducted have failed to either meet efficacy or safety measures. Notably, anti-nerve growth factor drugs that were superior to placebo had several adverse events that subsequently limited their usage. The aim of this paper is to highlight the current treatments under investigation that are in Phase II and III of development. This review searched trials that have been registered on clinicaltrials.gov with the term “osteoarthritis” and a primary completion date of 2021 or after that are in Phase II and III. This identified 252 studies, 52 of which were included in the review after screening and eligibility checks, that were then categorised as either targeting pain and inflammatory pathways or disease-modifying osteoarthritis drugs. Two further papers were included as they present two distinct therapies for hand OA. The results showed numerous avenues in development, with promising results, and provides hope to reduce the global burden of morbidity. It is important that these treatments are affordable for this chronic condition.