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01-01-2015 | Osteoarthritis | Book Chapter | Article

11. Safety Profile of Current OA Therapies: Evidence from Clinical Trials

Authors: PhD Anthony V. Perruccio, MBBS, MD, DM, PhD Vinod Chandran

Publisher: Springer International Publishing

Abstract

  • The pharmacologic management of osteoarthritis (OA) is primarily targeted at managing symptoms, and there are several classes of agents in current use. Many of these agents, though efficacious, are associated with adverse events.
  • Over time, the complement of adverse events under investigation has broadened, expanding from gastrointestinal (GI) events to also include cardiovascular (CV) and neurological events.
  • Pharmacologic management in OA is challenging, especially in older adults particularly due to comorbidities, different causes of pain, and a high rate of polypharmacy. In addition, while OA is treated as a homogeneous diagnostic category, there is evidence to suggest otherwise. This has implications for the pharmacologic management of OA and design of drug trials.
  • There is significant adverse GI risk associated with nonselective NSAIDs and adverse CV risk associated with both nonselective and selective NSAIDs.
  • While topical NSAIDs appear to have a better safety profile than oral NSAIDS, there can be some risk of GI and CVD adverse events associated with their use.
  • Intra-articular treatment for knee OA is generally associated with risk of mild adverse events of limited duration. However, there is an identified need for studies of longer follow-up with this intervention. With respect to the use of platelet-rich plasma (PRP), it is suggested that the inclusion of leukocytes in the treatment of OA be avoided.
  • Treatment with TNF blockers and IL-1β inhibition is generally well tolerated; majority of adverse events are graded as mild to moderate in severity. Further work with improved study designs is needed.
  • Favorable safety profiles are critical from a clinical perspective. Pragmatic studies that include a wider range of people, including the older age groups with a greater burden of arthritis, are necessary to inform clinical practice.

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