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By Amy Norton<\/b>
HealthDay Reporter<\/i><\/p>\n
TUESDAY, Aug. 4, 2020<\/p>\n
There are currently no medications that can slow down the common form of arthritis<\/a> that strikes aging<\/a> knees and hips. But a new study suggests a powerful, and expensive, anti-inflammatory drug could potentially do just that.<\/p>\n The drug, called canakinumab (Ilaris), is used for certain rare rheumatic conditions marked by widespread inflammation. They include juvenile idiopathic arthritis<\/a>, where the immune system mistakenly attacks the lining of the joints.<\/p>\n The new findings suggest the drug might hold promise for easing the highly common type of arthritis<\/a> that sets in with age: osteoarthritis<\/a>.<\/p>\n The researchers found that among 10,000 patients given canakinumab in a clinical trial, the risk of having a knee or hip replacement<\/a> was cut by at least 40% over four years. Those surgeries are generally done to treat severe osteoarthritis<\/a>.<\/p>\n However, the trial — funded by Ilaris-maker Novartis — has a major limitation: It was not actually designed to test the drug for osteoarthritis<\/a>. Instead, researchers wanted to know if it could prevent heart attacks<\/a> in high-risk people.<\/p>\n The reduction in joint replacements was a fortuitous finding.<\/p>\n “We’re hoping that this will stimulate further research,” said Dr. Paul Ridker, the senior researcher on the study. “These data derive from a very large trial, and they’re pointing to a potential new pathway in the treatment of osteoarthritis<\/a>.”<\/p>\n Canakinumab works by blocking interleukin-1 beta (IL-1\u03b2) — a chemical produced by the immune system that helps regulate the body’s inflammatory response. Recent studies have pointed to a role for IL-1\u03b2 in the inflammation that marks osteoarthritis.<\/p>\n “Back when I was in medical school, we learned that rheumatoid arthritis<\/a> was an inflammatory condition and osteoarthritis was ‘wear-and-tear,'” said Ridker, of Harvard Medical School and Brigham and Women’s Hospital, in Boston.<\/p>\n But, he said, the wear-and-tear concept is untrue, as osteoarthritis does seem to involve systemic inflammation.<\/p>\n In fact, a few small clinical trials<\/a> have tested various IL-1 inhibitors for easing the pain<\/a> of knee osteoarthritis. And they’ve come up empty.<\/p>\n But that, Ridker said, may simply be because the trials were too small and too short-term.<\/p>\n Dr. Nancy Lane, a professor and arthritis researcher at the University of California, Davis, agreed.<\/p>\n She praised the new study as “groundbreaking.” Even though the trial did not directly test canakinumab for arthritis, Lane said, the reduction in joint replacements is major.<\/p>\n “Right now, we have no treatments that prevent osteoarthritis or slow its progression,” Lane said.<\/p>\n At this point, she stressed, it’s not clear that canakinumab actually does slow joint degeneration. It’s possible it reduced people’s pain<\/a>, which can delay hip or knee replacements.<\/p>\n So that’s one of the questions for future research, Lane said.<\/p>\n Lane co-wrote an editorial accompanying the study, which was published online Aug. 3 in the Annals of Internal Medicine<\/i>.<\/p>\n The findings are based on a clinical trial that enrolled more than 10,000 people who’d suffered a heart attack<\/a>. The hope was to cut the risk of a repeat heart<\/a> attack by giving them canakinumab along with standard medications. Half of the patients were randomly assigned to take the drug, while the other half used a placebo.<\/p>\n Canakinumab was taken by injection, once every three months.<\/p>\n Ridker’s team found that over roughly four years, patients on the drug were 40% to 47% less likely to need joint replacement surgery, versus the placebo group.<\/p>\n There was one key element to the trial: All patients had elevated blood levels of C-reactive protein<\/a> (CRP). Ridker said this is a marker of chronic, low-grade inflammation in the body.<\/p>\n According to Lane, that raises an interesting possibility. Maybe there is a group of arthritis patients — those with high CRP — who are more likely to benefit from canakinumab.<\/p>\n Because the drug inhibits an immune system chemical, the main risk is that it can leave people more vulnerable to serious infections. In the heart disease<\/a> trial, patients given canakinumab had a somewhat lower heart attack<\/a> risk, but they also had a higher rate of fatal infections — though the risk was low overall.<\/p>\n If canakinumab is proven to prevent joint replacements, there will be a practical issue — the drug’s huge price tag, at thousands of dollars per injection. In 2018, the U.S. Food and Drug Administration rejected Novartis’s bid to have canakinumab approved for heart disease<\/a>; some cardiology experts had concluded the benefit was too small to justify expanding its use.<\/p>\n ![\"MedicalNews\"](\"https:\/\/images.medicinenet.com\/images\/HealthDay\/healthday.png\")
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