How close are we to having structure-modifying drugs available?
This article describes what structure modification is, explains the distinctions among preventing, retarding, stopping, and reversing disease, and suggests approaches that might be clinically meaningful. It discusses whether any evidence suggests it is possible to modify disease and whether the current focus on cartilage is appropriate. It considers the methodologic approaches and the obstacles to demonstrating efficacy of these agents in clinical trials. The authors hope that at the end of this narrative review the reader will appreciate the complexities of this rapidly evolving field and of the development of disease-modifying drugs for osteoarthritis drugs.
Hunter
David J
DJ
Division of Research, New England Baptist Hospital, 125 Parker Hill Ave., Boston, MA 02120, USA. djhunter@caregroup.harvard.edu
Hellio Le Graverand-Gastineau
Marie-Pierre
MP
D000276:Adjuvants, Immunologic / Q000627:therapeutic use; D000368:Aged; D002358:Cartilage, Articular / Q000187:drug effects*; D002809:Chondroitin Sulfates / Q000627:therapeutic use; D004318:Doxycycline / Q000627:therapeutic use; D016503:Drug Delivery Systems; D005260:Female; D005544:Forecasting; D005944:Glucosamine / Q000627:therapeutic use; D006621:Hip Joint / Q000187:drug effects; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use; D007719:Knee Joint / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000175:diagnosis / Q000188:drug therapy*; D020011:Protective Agents / Q000627:therapeutic use*; D012307:Risk Factors; D013583:Synovial Membrane / Q000187:drug effects*; D016896:Treatment Outcome
D000276:Adjuvants, Immunologic; D020011:Protective Agents; D006820:Hyaluronic Acid; D002809:Chondroitin Sulfates; D005944:Glucosamine; D004318:Doxycycline