1. The efficacy and safety of a fixed-dose combination of apocynin and paeonol, APPA, in symptomatic knee OA: A double-blind, randomized, placebo-controlled, clinical trial.
- Author
-
Bihlet AR, Byrjalsen I, Andersen JR, Reynolds A, Larkins N, Alexandersen P, Rovsing H, Moots R, and Conaghan PG
- Subjects
- Humans, Double-Blind Method, Male, Female, Middle Aged, Aged, Treatment Outcome, Drug Combinations, Anti-Inflammatory Agents, Non-Steroidal administration & dosage, Anti-Inflammatory Agents, Non-Steroidal therapeutic use, Severity of Illness Index, Adult, Acetophenones administration & dosage, Acetophenones therapeutic use, Acetophenones adverse effects, Osteoarthritis, Knee drug therapy, Pain Measurement
- Abstract
Objective: Apocynin (AP) and paeonol (PA) are low molecular weight phenolic compounds with a broad array of anti-inflammatory and immunoregulatory effects. This study assessed of a fixed-dose combination of APPA in people with symptomatic knee osteoarthritis (OA)., Methods: A multi-center, randomized, placebo-controlled, double-blind phase 2a trial enrolled participants with radiographic knee OA (Kellgren-Lawrence, KL, grades 2-3) and pain ≥40/100 on WOMAC pain subscale, and evaluated the efficacy and safety of oral APPA over a 28-day period. APPA 800 mg or matching placebo was administered twice daily in a 1:1 ratio. Post-hoc analyses explored the response to APPA in sub-groups with more severe pain and structural severity., Results: The two groups were comparable at baseline; 152 subjects were enrolled and 148 completed the trial. There was no statistically significant difference between groups with respect to the primary outcome, WOMAC pain (mean difference between groups was -0.89, 95% CI: -5.62, 3.84, p = 0.71), nor WOMAC function or WOMAC total. However, predefined subgroup analyses of subjects with symptoms compatible with nociplastic/neuropathic pain features showed a statistically significant effect of APPA compared to placebo. Adverse events (mainly gastrointestinal) were mild to moderate., Conclusion: Treatment with APPA 800 mg twice daily for 28 days in subjects with symptomatic knee OA was not associated with significant symptom improvement compared to placebo. The treatment was well-tolerated and safe. While the study was not powered for such analysis, pre-planned subgroup analyses showed a significant effect of APPA in subjects with nociplastic pain/severe OA, indicating that further research in the effects of APPA in appropriate patients is warranted., Competing Interests: Declaration of Competing Interest PGC has received consulting fees from AbbVie, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Galapagos, Genascence, GlaxoSmithKline, Janssen, Levicept, Novartis, Pfizer, Stryker and UCB. RM has no conflict of interest to declare. AR and NL are full-time employees and shareholders of AKL Therapeutics Ltd. ARB and JRA are employees and shareholder in NBCD A/S, and at the time of trial conduct and manuscript preparation, IB was a full-time employee of NBCD A/S. PA is a full-time employee of Sanos Clinic, Vejle, Denmark, and HR a full-time employee of Sanos Clinic Gandrup, Denmark., (Copyright © 2024 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF