MIV-711 not associated with pain reduction, but may reduce disease progression in osteoarthritis

1. MIV-711 not associated with pain reduction, but may reduce disease progression in osteoarthritis

Abstract: http://annals.org/aim/article/doi/10.7326/M19-0675

Editorial: http://annals.org/aim/article/doi/10.7326/M19-3809

URLs go live when the embargo lifts

MIV-711, a novel selective cathepsin K inhibitor, was not more effective than placebo for reducing pain related to knee osteoarthritis. However, MIV-711 significantly reduced bone and cartilage progression. Findings from a randomized, placebo-controlled study are published in Annals of Internal Medicine.

Osteoarthritis of the knee is a painful, disabling condition affecting more than 14 million people in the United States and hundreds of millions worldwide. The pain of knee OA arises from a series of pathologic processes involving articular cartilage, subchondral bone, synovium, meniscus, and other joint structures, ultimately leading to joint failure and pain-related functional limitations. Researchers sought to test the hypothesis that cathepsin K inhibitor could alleviate osteoarthritis symptoms by reducing degeneration of bone and cartilage.

In a multicenter study led by the University of Leeds, 244 patients with primary knee osteoarthritis were randomly assigned to receive either 100 or 200 mg daily of MIV-711 or matched placebo for 26 weeks to evaluate the efficacy, safety, and tolerability of MIV-711. The primary endpoint of the study was change in pain score, but changes in disease progression were also assessed using quantitative MRI outcomes. The researchers found that compared with placebo, MIV-711 was associated with less bone remodeling, less cartilage volume loss, and lower levels of bone resorption and collagen loss. However, it showed no beneficial effects on osteoarthritic knee pain. According to the authors, further evaluation is needed to confirm the structural benefits of MIV-711 and to determine whether these translate to more tangible benefits on disease symptoms.

The authors of an accompanying editorial from Brigham and Women's Hospital say that while the work is promising, they agree that more research is needed to determine the longer term benefits of MIV-711. They point out the study findings do not contradict that there is a foundational link between modification of structure and improvement in osteoarthritis pain, but rather clarify that changes in structure do not beget immediate changes in symptoms.

Media contacts: For embargoed PDFs please contact Lauren Evans at Laevans@acponline.org. To speak with the lead author, Philip G. Conaghan, PhD, please contact him at p.conaghan@leeds.ac.uk.

2. Fewer than half of California pharmacies provide correct drug disposal information

Abstract: http://annals.org/aim/article/doi/10.7326/M19-2409

URLs go live when the embargo lifts

Fewer than half of California pharmacies provided correct prescription drug disposal details to "secret shoppers" inquiring about unwanted medications. Only one tenth reported take-back programs at their location. That percentage dropped if participants called on a weekend. Findings from a brief research report are published in Annals of Internal Medicine.

Retail pharmacists are in an ideal position to provide drug disposal information, but evidence is limited regarding the accuracy of the information they provide. Researchers from the University of California, San Francisco identified licensed pharmacies located in urban and rural settings in California, a state that accounts for 10 percent of all U.S. pharmacies. They wrote a script that guided 4 male and 2 female "secret shoppers" to call and ask about how to dispose of leftover antibiotics (sulfamethoxazole-trimethoprim tablets) and a liquid opioid-based painkiller (hydrocodone-acetaminophen). From late-February to late-April 2018, the participants called 898 pharmacies and found that fewer than half provided correct disposal details, a percentage that dropped sharply if the callers made their call on a weekend. Asked specifically about drug take-back programs, just 11 percent said their pharmacy had one that could be used to dispose of antibiotics or opioids.

According to the researchers, these findings suggest that patients and pharmacy employees lack knowledge about proper medication disposal. Strengthening education of patients and those advising patients as well as expanding disposal programs could help to improve disposal practices.

Media contacts: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org.

To reach the lead author, Hillary Copp, MD, MS, please contact Laura Kurtzman at Laura.Kurtzman@ucsf.edu

Also new in this issue:

Eliminating Medical School Debt: A Dean and Geriatrician's View From Opposite Ends of the Training Pipeline

Mark S. Lachs, MD, MPH, and Augustine M.K. Choi, MD

Ideas & Opinions

Abstract: http://annals.org/aim/article/doi/10.7326/M19-2897

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