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Question clinique
Is tanezumab, a monoclonal antibody inhibitor, effective and safe for the treatment of moderate to severe knee or hip degenerative joint disease?
L’Essentiel
Tanezumab statistically significantly reduced pain and improved function in adults with moderate to severe hip or knee degenerative joint disease (DJD). It remains uncertain whether the improvements in pain and function scores are clinically significant. This study also raises the concern that tanezumab may increase the need for total joint replacement. 1b
Référence
Plan de l'etude: Randomized controlled trial (double-blinded)
Financement: Industry
Cadre: Outpatient (specialty)
Sommaire
Tanezumab is a monoclonal antibody that inhibits nerve growth factor binding, which, when uninhibited, enhances pain hypersensitivity. These investigators identified adults, 18 years and older, who met standard international diagnostic criteria for hip or knee osteoarthritis. Eligible patients had a documented history of insufficient pain relief from acetaminophen and insufficient pain relief or intolerance/contraindication to nonsteroidal anti-inflammatory drugs, tramadol, and opioids. Additional eligibility criteria included a pain subscale score of at least 5 (on a scale where 0 = no pain and 10 = extreme pain) and a baseline physical function score of at least 5 (on a scale where 0 = no difficulty and 10 = extreme difficulty). Study participants randomly received (concealed allocation assignment) 1 of 2 subcutaneous tanezumab treatment regimens (2.5 mg at baseline and again at week 8, or 2.5 mg at baseline and 5.0 mg at week 8) or matched placebo. Individuals masked to treatment group assignment assessed all outcomes. Complete follow-up occurred for 98.8% of participants at 16 weeks. Using intention-to-treat analysis, pain scores were significantly reduced in both tanezumab groups compared with the placebo group (mean differences vs placebo of -0.60 for tanezumab 2.5 mg and -0.73 for tanezumab 2.5/5 mg). Similarly, physical function disability scores were significantly reduced in both tanezumab groups compared with the placebo group (mean differences vs placebo of -0.66 for tanezumab 2.5 mg and -0.89 for tanezumab 2.5/5 mg). Since these differences are all less than 10% (1 point or more on the 11-point scale), it remains uncertain whether these are clinically significant. The total amount of rescue medication (acetaminophen) used was not significantly different among the 3 treatment groups. Of concern: More patients from both the 2.5 mg group and the 2.5/5 mg group underwent total joint replacements than from the placebo group (3.5% and 6.9% vs 1.7%, respectively).
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC
Commentaires
Assessment of % improvement
I would note that the % improvement was based on the maximum 11 point scale, where I believe a more appropriate baseline to determine % improvement would be the average baseline score and thus % improvement would have been significantly higher.
Was the increase in joint replacement statistically significant?
Also was there consideration of the possibility that the improvement this group experienced made them more likely to request definitive treatment.
Subject: The importance of TANEZUMAB for patients /clients.
Dear Respected Team-CMA-Canada,
Thank you my Dear Respected Sir for your previous cooperation to me towards discussion/comments.
TANEZUMAB is very important for patients.Due to joint pain/knee pain/backbone pain and related to this problems ,it helps the patients/clients for soon recovery . Doctors /Nurse Doctors /Movement and Disorders Doctors can see the guideline for treatment of patients/clients.
I have already read the tropics about this health related problems of patients/clients.
Best wishes. Respectfully.
Dr.Muhammad Arif Rana
Global Family Doctor(LDM -224)-WONCA at SIG Based in Manikganj-Bangladesh.
International Resident Member (IMG)-CMAID-680777-CMA-Canada.
Heath Professional Member-52698-MDS-USA.
(SIG)
Manikganj-Bangladesh.
Date : October 11-2019-Friday -08:21 PM.
(With warmest wishes and Respectfully)