Osteoarthritis treatment breakthrough13 Sep 2017
A 60-year-old drug may be the answer to one of the nation’s most debilitating forms of arthritis – osteoarthritis.
This painful condition affects more than 1.6 million Australians, most of whom are of working age.
A case study that has been peer-reviewed and accepted for publication in the prominent journal, BMC Musculoskeletal Disorders, has shown to be a potentially groundbreaking treatment for osteoarthritis.
The drug has the potential to substantially reduce the need for knee replacements.
The case study involved a 70-year-old Adelaide based woman with advanced osteoarthritis on a waiting list for a complete knee replacement. The treatment involved the drug Zilosul (pentosan polysulfate sodium, or PPS which was injected by her doctor, Professor Jegan Krishnan.
The patient was suffering from pain and swollen knee joints which was associated with Bone Marrow Edema Lesions (BMEL) detected by an MRI scan. Bone Marrow Edema Lesions (BMEL) are considered the root cause of pain in advanced osteoarthritis.
MRI scans taken only two weeks after treatment showed the BMEL had totally disappeared, and that there was a marked improvement in knee movement and joint swelling.
Patient’s pain score, which, before the treatment was an 8 out of 10, dropped to 0.
Paradigm Biopharma CEO Paul Rennie said current treatments, such as non-steroidal, anti-inflammatories (nurofen, aspirin), opiates such as morphine and codeine and corticosteroids only address the symptoms – and not the cause – of osteoarthritic knee pain.
Limited treatment options
“At present, there are no registered products for the treatment of subchondral Bone Marrow Edema Lesion (BML) and the associated knee pain in osteoarthritis,” he said.
“Patients who do not respond to current anti-inflammatory therapies are left with limited treatment options, and their treatment options may include powerful pain killer medication or even surgery, such as total knee reconstruction.
“PPS treatment will provide long term improvements in pain management in people with osteoarthritis without the need for daily repeated medications, as in the case of nonsteroidal, anti-inflammatories, which cause gastrointestinal side effects. In addition, long-term treatment with corticosteroids has not shown long term benefits."
The patient involved in the case study is an extremely active woman “with the energy of people half (her) age”, is a former horse rider, and has, for years, suffered from physical pain left over from injuries sustained during her riding days.
But over the last 12 months, her knee pain had become so excruciating that no over the counter drugs, such as painkillers, could help her. She stopped going outside; she could no longer live the active existence she craved.
“It got to a point that my condition was not showing any improvement. So when I was offered a chance to use this drug and to see how I would go, I jumped on it. At that stage, I would have tried anything,” she said.
“I was like an invalid; it was very depressing”.
Almost immediate pain relief
During the treatment period, she was injected with PPS by her doctor twice a week for three weeks. The pain relief was almost immediate.
“After the injections, the pain disappeared. I'm no longer on the list for a knee reconstruction; not even thinking about it anymore. I walk nearly 10km every morning,” she said. “I am now looking into getting PPS to treat my other ailments, namely my back pain.”
The results observed as a case study have been further substantiated in 24 other patients with BMEL and advanced osteoarthritis also showing a marked improvement in the pain scores and joint function who have completed treatment with an additional 6 patients currently undergoing treatment.
Mr Rennie said these results are significant, as they show relief for sufferers and the potential to ease the pressures in the public hospital and health care system in managing pain and total knee replacements in osteoarthritic patients.
“As some of these patients were taken off a public hospital waiting list for total knee replacement, it saved them from this invasive and painful procedure.
“This has wider health care implications, as every person taken off the knee reconstruction list saves the hospital and health care system the cost of the operation and cost of the replacement joint,” he said.
Paradigm Biopharmaceuticals is an ASX-listed company based in Melbourne.