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Imaging in osteoarthritis trials: useful or just expensive?

Nature Clinical Practice Rheumatology volume 5, pages 76–77 (2009)Cite this article

The development of new disease-modifying osteoarthritis drugs (DMOADs) is clearly lagging behind other therapeutic fields, and major progress is urgently needed. In contrast, significant advances in the treatment of inflammatory diseases have been made with the successful development of several new DMARDs. The rapid progression of rheumatoid arthritis and the extent of joint structural changes make assessment of disease progression possible using conventional imaging techniques, such as radiography. Changes in osteoarthritis (OA), however, develop much more slowly. Nevertheless, in diseases such as rheumatoid arthritis, MRI is fast becoming the technology of choice for the assessment of disease activity progression and response to therapy.1 In this Viewpoint article, we promote the use of MRI technology in clinical trials investigating the effectiveness of DMOADs, as this technique would provide meaningful information to assist the development of optimum treatment strategies for patients with OA.

The development of DMOADs is facing a number of challenges, including the reliability and sensitivity of the technology used to assess the effectiveness of treatment. Radiography is still recognized by most regulatory agencies as the gold standard for knee or hip DMOAD clinical trials in which the progression of the disease is assessed by the measurement of joint space loss. This technique, however, has several significant limitations,2,3 in that it only allows for the assessment of cartilage loss on focal weight-bearing areas of the joint, as demonstrated in a MRI study,4 as well as weak sensitivity to change. This latter limitation was convincingly demonstrated in a large-scale phase III DMOAD study,5 involving several thousand patients with knee OA, which evaluated the effect of risedronate, an antiresorptive agent. Briefly, this study explored, using a range of doses, the efficacy of risedronate in reducing signs and symptoms of OA and in slowing radiographic progression. Data showed that only a small percentage of patients (13%) demonstrated significant joint space narrowing over 2 years, giving a clear indication of the large number of patients required in such a trial in order to achieve statistical significance. In fact, this might have been one of the causes for the failure of this trial.

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  1. J-P Pelletier is a Rheumatologist and Full Professor of Medicine and J Martel-Pelletier is a Full Professor of Medicine at the Faculty of Medicine, University of Montréal, Québec, Canada.,

    Jean-Pierre Pelletier & Johanne Martel-Pelletier

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  1. Jean-Pierre Pelletier
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  2. Johanne Martel-Pelletier
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Correspondence to Jean-Pierre Pelletier.

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J-P Pelletier and J Martel-Pelletier have declared that they receive grant/research support (including clinical trials) from Merckle GmbH, and that they have both acted as consultants, are stockholders/directors and patent holders/applicants on behalf of Arthrolab Inc. and ArthroVision Inc.

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Pelletier, JP., Martel-Pelletier, J. Imaging in osteoarthritis trials: useful or just expensive?. Nat Rev Rheumatol 5, 76–77 (2009). https://doi.org/10.1038/ncprheum0990

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