Comparative Orthopaedic Research Laboratory, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA.
BMC Vet Res. 2012 Oct 4;8:185. doi: 10.1186/1746-6148-8-185.
BACKGROUND: Pain and impaired mobility because of osteoarthritis (OA) is common in dogs and humans. Efficacy studies of analgesic drug treatment of dogs with naturally occurring OA may be challenging, as a caregiver placebo effect is typically evident. However, little is known about effect sizes of common outcome-measures in canine clinical trials evaluating treatment of OA pain. Forty-nine client-owned dogs with hip OA were enrolled in a randomized, double-blinded placebo-controlled prospective trial. After a 1 week baseline period, dogs were randomly assigned to a treatment (ABT-116 - transient receptor potential vanilloid 1 (TRPV1) antagonist, Carprofen - non-steroidal anti-inflammatory drug (NSAID), Tramadol - synthetic opiate, or Placebo) for 2 weeks. Outcome-measures included physical examination parameters, owner questionnaire, activity monitoring, gait analysis, and use of rescue medication. RESULTS: Acute hyperthermia developed after ABT-116 treatment (P < 0.001). Treatment with carprofen (P ≤ 0.01) and tramadol (P ≤ 0.001) led to improved mobility assessed by owner questionnaire. Nighttime activity was increased after ABT-116 treatment (P = 0.01). Kinetic gait analysis did not reveal significant treatment effects. Use of rescue treatment decreased with treatment in the ABT-116 and Carprofen groups (P < 0.001). Questionnaire score and activity count at the end of treatment were correlated with age, clinical severity at trial entry, and outcome measure baseline status (SR ≥ ±0.40, P ≤ 0.005). Placebo treatment effects were evident with all variables studied. CONCLUSION: Treatment of hip OA in client-owned dogs is associated with a placebo effect for all variables that are commonly used for efficacy studies of analgesic drugs. This likely reflects caregiver bias or the phenomenon of regression to the mean. In the present study, outcome measures with significant effects also varied between groups, highlighting the value of using multiple outcome measures, as well as an a priori analysis of effect size associated with each measure. Effect size data from the present study could be used to inform design of future trials studying analgesic treatment of canine OA. Our results suggest that analgesic treatment with ABT-116 is not as effective as carprofen or tramadol for treatment of hip arthritis pain in client-owned dogs.
背景:由于骨关节炎(OA),疼痛和活动能力受损在狗和人类中很常见。对患有自然发生的 OA 的狗进行镇痛药物治疗的疗效研究可能具有挑战性,因为通常会出现照顾者安慰剂效应。但是,对于评估 OA 疼痛治疗的犬临床研究中常见结局测量的效果大小知之甚少。49 只患有髋关节 OA 的客户拥有的狗参加了一项随机,双盲,安慰剂对照的前瞻性试验。经过 1 周的基线期后,狗被随机分配到治疗组(ABT-116-瞬时受体电位香草素 1(TRPV1)拮抗剂,卡洛芬-非甾体抗炎药(NSAID),曲马多-合成阿片类药物或安慰剂)2 周。结局测量包括体格检查参数,所有者问卷,活动监测,步态分析和抢救药物的使用。
结果:ABT-116 治疗后出现急性发热(P <0.001)。卡洛芬(P ≤0.01)和曲马多(P ≤0.001)治疗可改善所有者问卷评估的活动能力。ABT-116 治疗后夜间活动增加(P = 0.01)。动力学步态分析未显示出明显的治疗效果。ABT-116 和卡洛芬组的抢救治疗减少了(P <0.001)。治疗结束时的问卷评分和活动计数与年龄,试验开始时的临床严重程度以及结局测量的基线状态相关(SR ≥±0.40,P ≤0.005)。在研究的所有变量中,都观察到了安慰剂治疗效果。
结论:患有髋关节 OA 的客户的狗的治疗与所有常用的镇痛药物疗效研究变量的安慰剂效应有关。这可能反映了照顾者的偏见或回归平均值的现象。在本研究中,具有显著效果的结局测量指标在各组之间也有所不同,这突出了使用多种结局测量指标以及对每个指标相关的效应量进行预先分析的价值。本研究的效应量数据可用于为研究犬 OA 镇痛治疗的未来试验提供信息。我们的结果表明,与卡洛芬或曲马多相比,ABT-116 治疗对患有髋关节关节炎疼痛的客户拥有的狗的镇痛作用不那么有效。
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