Emerging injectable therapies for osteoarthritis: an update and narrative review.

Abstract

Aim: Not only does osteoarthritis (OA) negatively impact patients on an individual level; this condition also comes at significant cost to society. The societal consequences of the rising rates of OA in our aging population (such as time off work, falls, hospital admissions, presentations to general practitioners) have previously been well documented. The global pandemic, however, has added another layer of consideration when managing patients with OA. Elective arthroplasty may not be as readily available as it once was and referring patients for such procedures may only increase strain on the hospital system. Now more than ever, a review of emerging injectable options to expand our therapeutic armamentarium seems timely and important. Method(s): We conducted a literature review using PubMed and MEDLINE databases to identify randomised controlled trials of novel injectable therapies for OA, limited to English and at least phase II clinical trials in humans. Result(s): We identified randomised controlled trials of novel injectable agents being explored in the treatment of OA. The proposed mechanisms behind these therapies include targeting inflammatory pathways (such as inhibitors of interleukin-1, tumour necrosis factor and granulocytemacrophage colony stimulating factor); nociceptive pathways (such as nerve growth factor inhibitors and imidazoline-2 receptor agonists); and cartilage regeneration pathways (such as recombinant fibroblast growth factor and Wnt pathway inhibitors). Conclusion(s): There are numerous emerging injectable therapies which show promise for the treatment of OA in at least phase II trials. While this review does not justify a change in current practise, the heterogenous nature of OA and the multifaceted pathways involved in disease progression should be considered in future potential treatment options.