Tesch Ricardo de Souza, Carias Rosana Bizon Vieira, Calcia Thayanne Brasil Barbosa, Borchio Priscila Grion de Miranda, Takamori Esther Rieko
Petrópolis Medical School/UNIFASE/Regenerative Medicine Laboratory, Petrópolis, Brazil.
Petrópolis Medical School/UNIFASE/Clinical Research Center, Petrópolis, Brazil.
J Oral Rehabil. 2025 Oct;52(10):1674-1681. doi: 10.1111/joor.14012. Epub 2025 May 19.
Temporomandibular joint osteoarthritis (TMJ-OA) presents a significant clinical challenge, marked by limited therapeutic options and variable patient responses. While regenerative therapies show promising results, conventional clinical trial methodologies often fail to demonstrate a significant clinical difference, largely due to response variabilities, which is critical in complex conditions like TMJ-OA. As such, methodologies traditionally used in clinical trials for regenerative therapies targeting TMJ-OA may need to be restructured to better identify and accommodate the distinctive profiles of responders and non-responders.
This paper proposes a revised clinical trial framework that focuses on differentiating responders from non-responders within treatment groups, rather than relying solely on traditional control groups.
Analysing non-responders provides valuable insights for therapeutic individualisation and optimises patient selection, as understanding predictive factors can lead to improved outcomes. We present recommendations that integrate imaging diagnostics, chronic pain characteristics, and psychosocial assessments, offering a novel approach to enhance efficacy of TMJ-OA treatment.
This work advocates for a re-evaluation of standard clinical trial designs to support more personalised and effective strategies for the management of TMJ-OA.
颞下颌关节骨关节炎(TMJ - OA)是一项重大的临床挑战,其特点是治疗选择有限且患者反应各异。虽然再生疗法显示出有前景的结果,但传统的临床试验方法往往未能证明有显著的临床差异,这主要是由于反应的变异性,而这在像TMJ - OA这样的复杂病症中至关重要。因此,传统上用于针对TMJ - OA的再生疗法临床试验的方法可能需要重新构建,以更好地识别和适应反应者与无反应者的不同特征。
本文提出了一个修订后的临床试验框架,该框架侧重于区分治疗组内的反应者与无反应者,而不是仅仅依赖传统的对照组。
分析无反应者可为治疗个体化提供有价值的见解并优化患者选择,因为了解预测因素可带来更好的结果。我们提出了整合影像诊断、慢性疼痛特征和心理社会评估的建议,提供了一种提高TMJ - OA治疗效果的新方法。
这项工作主张重新评估标准临床试验设计,以支持更个性化和有效的TMJ - OA管理策略。