US20120316217A1 - combination for the treatment of osteoarthritis - Google Patents
combination for the treatment of osteoarthritis Download PDFInfo
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- US20120316217A1 US20120316217A1 US13/517,307 US201013517307A US2012316217A1 US 20120316217 A1 US20120316217 A1 US 20120316217A1 US 201013517307 A US201013517307 A US 201013517307A US 2012316217 A1 US2012316217 A1 US 2012316217A1
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- United States
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- osteoarthritis
- formulation
- months
- treatment
- pain
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- 201000008482 osteoarthritis Diseases 0.000 title claims abstract description 30
- 238000011282 treatment Methods 0.000 title claims abstract description 20
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Definitions
- the present invention relates to a combination of glycine, proline, and optionally a natural or synthetic viscosity-controlling polymer, and/or lysine and/or leucine, for the treatment of osteoarthritis, in particular for patellofemoral or femorotibial osteoarthritis of the knee, osteoarthritis of the hip and osteoarthritis of the shoulder.
- Osteoarthritis is the most common joint disease among the rheumatic disorders affecting the Western world. It is a chronic degenerative joint disease which may be diffuse or localised, affecting the cartilage of the diarthrodial joints, where the normal metabolic process of the chondrocytes is impaired, leading to softening, fibrillation, ulceration and subsequent sclerosis of the subchondral bone, and in the final stages to new bone formation and subchondral cysts.
- Osteoarthritis which mainly affects women, most frequently involves the patellofemoral joint, the femorotibial joint, the hip and the shoulder. Osteoarthritis of the knee, or gonarthritis, is particularly frequent and disabling.
- the clinical picture is initially dominated by characteristically mechanical pain at the anterior or anteromedial site, which is attenuated by rest. After lengthy inactivity, for example in the mornings or after sitting for a long time, painful post-inactivity spasms may be experienced. However, they are shortlived, and attenuated by walking. Pain may be triggered by using stairs, especially walking downstairs, squatting, especially in the case of patellofemoral osteoarthritis, or lengthy use of vehicle pedals.
- knee osteoarthritis requires a combination of pharmacological and other treatments, which must be tailored to the patient's requirements on the basis of local risk factors (obesity, mechanical factors, physical activity), general risk factors (age, comorbidity, multiple drug therapy), pain intensity levels and degree of disability, signs of inflammation (effusion), location and degree of structural damage.
- local risk factors ovality, mechanical factors, physical activity
- general risk factors age, comorbidity, multiple drug therapy
- pain intensity levels and degree of disability signs of inflammation (effusion), location and degree of structural damage.
- Non-pharmacological treatment of knee osteoarthritis should include rehabilitation programmes, physical exercise, the use of aids (walking sticks, insoles or knee braces) and weight loss, where necessary.
- the first-line medicament for the treatment of pain in knee osteoarthritis is paracetamol, which is used at doses lower than or equal to 3 gm/day in addition to other osteoarthritis drugs.
- Topical applications of NSAIDs or capsaicin can be a useful treatment if used for short periods, especially for patients who refuse or are unable to take oral medicaments.
- NSAIDs are considered for patients who fail to respond to paracetamol and patients at gastrointestinal risk; in that case, conventional COXIBs or NSAIDs associated with proton pump inhibitors are used.
- Opioid analgesics represent useful alternatives in patients for whom NSAIDs or COXIBs are contraindicated because they are ineffective or poorly tolerated.
- Other drugs used are those which, when administered by the oral or intra-articular route, reduce the clinical symptoms at varying rates, by different methods from analgesics or NSAIDs.
- This group consists of two different categories: slow-acting symptomatic medicaments for osteoarthritis, and medicaments able to modify the progress of osteoarthritis.
- Glucosamine sulphate, chondroitin sulphate, soya and avocado extracts, diacerein, hyaluronic acid and S-adenosylmethionine belong to the first group.
- These medicaments have a direct action on the chondrocytes and synoviocytes and consequently have beneficial effects on the cartilage structure. Their efficacy against the symptoms starts slowly (1-2 weeks) but lasts for a long time: up to two months after discontinuance of the treatment.
- Intra-articular injection of cortisones with a long-lasting action is indicated for acute joint pain, especially if it is associated with intra-articular effusions.
- intra-articular compositions comprising glycine, proline, and optionally a natural or synthetic viscosity-controlling polymer, lysine and/or leucine, is effective in the treatment of osteoarthritis, especially as regards the aspect of pain management.
- compositions according to the invention have a significant effect on pain reduction and improvement in the joint function, and consequently on the patient's quality of life. This effect is long-lasting, even after the treatment is discontinued (up to two months).
- compositions according to the invention therefore provides a useful treatment for osteoarthritis, especially in pain management, offering fast, effective pain reduction.
- the present invention therefore relates to a combination comprising:
- osteoarthritis in particular knee osteoarthritis.
- the natural or synthetic viscosity-controlling polymer is selected from hyaluronic acid or a salt thereof, polyvinylpyrrolidone, and cellulose derivatives.
- the natural or synthetic viscosity-controlling polymer is hyaluronic acid or a salt thereof.
- aminoacids are present in the L form.
- the intra-articular compositions according to the invention will contain the various active constituents in the following composition ranges by weight:
- compositions according to the invention are formulated suitably for intra-articular administration in the form of reconstitutable powders, solutions and the like, and will be prepared according to conventional methods well known in pharmaceutical technology, such as those described in Remington's Pharmaceutical Handbook, Mack Publishing Co., N.Y., USA, using excipients suitable for their final use.
- the purpose of the trial was to evaluate the therapeutic efficacy of intra-articular administration of a composition according to the invention in patients suffering from primary osteoarthritis of the knee by assessing the thickness of the cartilage, the intensity of pain and the patients' quality of life before and after treatment.
- composition according to the invention used for the trial consisted of 2 bottles: bottle A, containing sodium hyaluronan in aqueous solution; and bottle B, containing a freeze-dried powder based on glycine (182 mg), L-proline (150 mg), L-lysine (35 mg) and L-leucine (21 mg).
- the product Before administration, the product must be reconstituted (the freeze-dried powder in bottle B is dissolved in the solution contained in bottle A) to provide a transparent solution containing no particulate matter.
- the area to be treated was disinfected, and then anaesthetised with an anaesthetic cream to be applied 30 minutes before the operation.
- the infiltrations were repeated once a week for 5 weeks.
- VAS visual analogue scale
- Thickness of knee joint cartilage in the central, medial and lateral compartment by means of an ultrasound scan (performed with a Philips Envisor 250 ultrasound system with multifrequency linear probe from 5 to 13 MHz).
- composition according to the invention was well tolerated, with no local or systemic allergic reactions.
- results of the clinical evaluation are set out in Tables I and II.
- the mean pain value (VAS) evaluated by patients at the beginning of the trial was 58.03 ( ⁇ 8.31); after three months, the mean value was 28.07 ( ⁇ 8.55), a percentage decrease of 58% (p ⁇ 0.05); and after six months the mean value had fallen to 16.20 ( ⁇ 9.28) (p ⁇ 0.05).
- the mean pain value (VAS) evaluated by the doctors at the beginning of the trial was 56.18 ( ⁇ 9.66); after three months, the mean value was 22.03 ( ⁇ 7.32), a percentage decrease of 54% (p ⁇ : 0.05); after six months the mean value had fallen still further, to 9.11 mm ( ⁇ 6.97), a percentage decrease of 71% compared with baseline (p ⁇ 0.05).
- the mean thickness of the central cartilage after three months (0.29 mm ⁇ 0.07) was not significant, whereas after six months (0.31 ⁇ 0.11 mm) there was a statistically significant increase compared with the baseline value.
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Applications Claiming Priority (3)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| ITMI2009A002256A IT1397522B1 (it) | 2009-12-21 | 2009-12-21 | Uso di una combinazione per il trattamento dell'osteoartrosi |
| ITMI2009A002256 | 2009-12-21 | ||
| PCT/EP2010/069451 WO2011076596A1 (en) | 2009-12-21 | 2010-12-13 | A combination for the treatment of osteoarthritis |
Related Parent Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| PCT/EP2010/069451 A-371-Of-International WO2011076596A1 (en) | 2009-12-21 | 2010-12-13 | A combination for the treatment of osteoarthritis |
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| US13/947,538 Continuation US9040575B2 (en) | 2009-12-21 | 2013-07-22 | Combination for the treatment of osteoarthritis |
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| US20120316217A1 true US20120316217A1 (en) | 2012-12-13 |
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| US13/947,538 Active 2031-01-03 US9040575B2 (en) | 2009-12-21 | 2013-07-22 | Combination for the treatment of osteoarthritis |
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| RU2549436C1 (ru) * | 2014-06-06 | 2015-04-27 | Государственное бюджетное образовательное учреждение высшего профессионального образования "Ростовский Государственный медицинский университет" Министерства здравоохранения Российской Федерации (ГБОУ ВРО РостГМУ Минздрава России) | Способ лечения больных плечелопаточным периартрозом |
| JPWO2020009191A1 (ja) * | 2018-07-04 | 2021-08-02 | 味の素株式会社 | 高齢動物の疼痛緩和用アミノ酸含有組成物 |
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| US20080249065A1 (en) * | 2005-10-26 | 2008-10-09 | Franco Conti | Ophthalmic Pharmaceutical Compositions Based on Amino Acids and Sodium Hyaluronate |
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| IT1304191B1 (it) * | 1998-12-18 | 2001-03-08 | Solartium Establishment | Composizione farmaceutica a base di prolina, glicina e lisina utilenella terapia odontoiatrica sia sotto forma iniettabile che in |
| IT1318556B1 (it) * | 2000-06-07 | 2003-08-27 | Solartium Establishment | Composizione farmaceutica a base di prolina, glicina e lisina utilenella terapia per la cicatrizzazione delle ferite e delle lesioni |
| YU75003A (sh) * | 2002-01-11 | 2006-08-17 | Matthias Rath | Nutriciona farmaceutska formulacija koja uključuje polifenole i upotreba u tretmanu kancera |
| US20050053673A1 (en) * | 2003-09-05 | 2005-03-10 | Shrirang Netke | Composition and method for facilitating bone healing |
| US20050176807A1 (en) * | 2004-02-09 | 2005-08-11 | Friesen Kim G. | Composition and method for use in cartilage affecting conditions |
| US20060029647A1 (en) * | 2004-02-09 | 2006-02-09 | Friesen Kim G | Composition and method for use in cartilage affecting conditions |
| WO2006067608A1 (en) * | 2004-12-22 | 2006-06-29 | Laboratoire Medidom S.A. | Aqueous formulations based on sodium hyaluronate for parenteral use |
| ITMI20051230A1 (it) * | 2005-06-29 | 2006-12-30 | Pharmaperoducts Uk Ltd | Composizioni farmaceutiche e cosmetiche contenenti colostro tocoferoli ossido di zinco e acido ialuronico |
| ITMI20052037A1 (it) * | 2005-10-26 | 2007-04-27 | Professional Dietetics Srl | Composizioni farmaceutiche cicatrizzanti sotto forma di polvere sterile a base di amminoacidi e sodio ialuronato |
| JP2007161688A (ja) * | 2005-12-16 | 2007-06-28 | Hiroshima Univ | 軟骨生成促進剤 |
| ITPD20060219A1 (it) * | 2006-05-31 | 2007-12-01 | Fidia Farmaceutici | Composizioni farmaceutiche contenenti acido ialuronico solfatato nel trattamento dell'osteoartrosi |
| JP2009120512A (ja) * | 2007-11-13 | 2009-06-04 | Nitta Gelatin Inc | 関節軟骨再生促進剤 |
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| US20080249065A1 (en) * | 2005-10-26 | 2008-10-09 | Franco Conti | Ophthalmic Pharmaceutical Compositions Based on Amino Acids and Sodium Hyaluronate |
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| Publication number | Publication date |
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| EP2515897A1 (en) | 2012-10-31 |
| CA2785116A1 (en) | 2011-06-30 |
| US20130310437A1 (en) | 2013-11-21 |
| RS53197B (en) | 2014-06-30 |
| RU2012125823A (ru) | 2013-12-27 |
| ITMI20092256A1 (it) | 2011-06-22 |
| BR112012015124A8 (pt) | 2017-12-26 |
| IT1397522B1 (it) | 2013-01-16 |
| KR20120095451A (ko) | 2012-08-28 |
| US9040575B2 (en) | 2015-05-26 |
| EP2515897B1 (en) | 2013-12-04 |
| PL2515897T3 (pl) | 2014-05-30 |
| ES2447829T3 (es) | 2014-03-13 |
| RU2560844C2 (ru) | 2015-08-20 |
| BR112012015124A2 (pt) | 2017-06-20 |
| JP2013515024A (ja) | 2013-05-02 |
| CA2785116C (en) | 2017-09-05 |
| BR112012015124B1 (pt) | 2021-06-15 |
| CN102665708A (zh) | 2012-09-12 |
| CN102665708B (zh) | 2014-11-05 |
| WO2011076596A1 (en) | 2011-06-30 |
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