University of Montreal Hospital Research Centre (CRCHUM), Osteoarthritis Research Unit , 1560 Sherbrooke Street East, Montreal, Quebec , Canada.
Expert Opin Pharmacother. 2013 Oct;14(15):2059-77. doi: 10.1517/14656566.2013.825606.
Osteoarthritis (OA) is a dynamic process involving the main tissues of the joint for which a global approach should be considered. No disease-modifying OA drug (DMOAD) has yet been approved. New therapeutic strategies are needed that would be cost effective by reducing the need for pharmacological interventions and surgical management while targeting specific pathways leading to OA. The treatment landscape of OA is about to change based on new agents having shown some structural effects and emerging therapies with DMOAD effects.
In this review based on a Medline (via PubMed) search, promising new and emerging therapies with a potential structural effect (DMOAD) will be discussed including growth factors, platelet-rich plasma, autologous stem cells, bone remodeling modulators, cytokine inhibition, gene therapy, and RNA interference.
DMOAD development should focus on targeting some phenotypes of OA patients evidenced with sensitive techniques such as magnetic resonance imaging, as a single treatment will unlikely be appropriate for all OA patients. This will allow the development of DMOADs based on personalized medicine. An exciting new era in DMOAD development is within reach, provided future clinical trials are sufficiently powered, systematically designed, use the appropriate evaluation tools, and target the appropriate categories of OA patients.
骨关节炎（OA）是一个涉及关节主要组织的动态过程，应考虑采用整体方法。目前尚无被批准的骨关节炎药物（DMOAD）。需要新的治疗策略，通过减少对药理学干预和手术管理的需求，同时针对导致 OA 的特定途径，从而具有成本效益。基于具有一定结构作用的新药物和新兴治疗方法具有 DMOAD 作用，OA 的治疗前景即将发生变化。
本综述基于 Medline（通过 PubMed）检索，将讨论具有潜在结构作用（DMOAD）的有前途的新型和新兴治疗方法，包括生长因子、富含血小板的血浆、自体干细胞、骨重塑调节剂、细胞因子抑制、基因治疗和 RNA 干扰。
DMOAD 的开发应侧重于针对某些 OA 患者的表型，这些表型可通过磁共振成像等敏感技术得到证实，因为单一治疗不太可能适合所有 OA 患者。这将允许基于个体化医学开发 DMOAD。如果未来的临床试验具有足够的效力、系统地设计、使用适当的评估工具并针对适当的 OA 患者类别，那么 DMOAD 开发的令人兴奋的新时代即将到来。
