My only commentary would be that these results do not read like clinical success, but rather something suggesting they should move on to phase III clinical trials.
This is the only publication I found in a quick search:
Objectives: Nerve growth factor β (β-NGF) is a protein which is important to the development of neurons particularly those involved in the transmission of pain and is central to the experience of pain in osteoarthritis (OA). Direct NGF antagonism has been shown to reduce OA pain but is associated with rapidly progressive OA. The aim of the study is to investigate the ability of soluble neurotrophin receptors in the NGF pathway to modulate pain in OA.
Methods: Synovial fluid (SF) was obtained from the knee joints of 43 subjects who underwent total knee arthroplasty. Visual analogue scale (VAS) pain scores were obtained prior to surgery. Customised-automated-ELISAs and commercial-ELISAs and LEGENDplex™ were used to measure soluble low-affinity nerve growth factor (LNGFR), soluble tropomyosin receptor kinase (TrkA), proNGF, β-NGF, other neurotrophins (NT) and cytokines including inflammatory marker TNF-α.
Results: The VAS score positively correlated with β-NGF (r=0.34) and there was positive association trend with neurotrophin-3 (NT-3), BDNF and negative association trend with ProNGF. sLNGFR positively correlated with VAS (r=0.33). The β-NGF/soluble TrkA ratio showed a strong positive correlation with VAS (r=0.80). In contrast, there was no correlation between pain and the β-NGF/sLNGFR ratio (r=-0.08). TNF-α positively correlated with β-NGF (r=0.83), NT-3 (r=0.66), and brain-derived neurotrophic factor (BDNF) (r=0.50) and negatively with ProNGF (r= -0.74) and positively correlated with both soluble TrkA (r=0.62), sLNGFR (r=0.26).
Conclusions: This study suggests that endogenous or cleaved sLNGFR, but not soluble TrkA may participate in OA pain modulation thus supporting further research into soluble LNGFR as a therapeutic target in OA.
Sounds significant. Phase II is typically not enough to tell if a drug is good because most drugs aren’t that effective compared to current standard of care- you need the large numbers of phase iii to see the real difference. But looks like this drug shows a marked improvement in phase ii itself so it’s actually quite impressive. Last time I read such a story was for imatinib. Expecting good things from this.
The thing with chronic pain is that often it is garbage data being sent by pain receptors. Or more accurately our muddled processing of the nerve impulses leads to poorly established thresholds that lead to a constant presence of perceived pain. So preventing this pathology based on my experience is a cure. Physical regeneration is a separate target in my opinion.
A cure for much arthritis is possibly a Nutritarian Diet promoted by Dr. Joel Fuhrman which reduces inflammation and helps the body rebuild:
https://www.drfuhrman.com/blog/119/a-progressive-approach-to...
"The traditional treatment of rheumatoid arthritis revolves around medications which typically include steroids and chemotherapeutic agents such as methotrexate, Imuran®, Gold®, Plaquenil®, Arava® and Remicade®. These medications are considerably toxic and can result in serious disability.
My approach to treating rheumatoid arthritis differs in that it incorporates dietary modifications and nutritional supplements, avoiding the use of toxic drugs in the vast majority of cases. The recommendations are customized to the needs and response of each patient to treatment and involve more than just putting them on a special diet. However, in most cases, dramatic improvements and even complete recoveries occur.
In spite of well-conducted scientific investigations and the clinical experience of many physicians, this effective nutritional treatment of autoimmune disease is generally ignored. I have seen scores of patients with rheumatoid arthritis as well as lupus, fibromyalgia and connective tissue disease obtain complete recoveries through these natural interventions. Also, I have many patients who have made complete recoveries from allergies and asthma. Not every patient obtains a complete remission, but the majority is able to avoid the use of medication."
The big problem in our current society is that there is no substantial money to be made by big companies in promoting these sorts of cures.
Methotrexate is the most vile substance (made one day per week about as useful as a full day hangover) It did help but honestly only as much as the effort I put into a diet change. I completely agree with parent comment.
Anyone with an autoimmune disorder or chronic inflammation who has not experienced an elimination diet is doing themselves a huge disservice.
> It sounds like, even in the best case scenario, the drug doesn't really cure arthritis but just blunts the pain.
> I was thinking it would be something that helps the worn ligament grow back. That I would consider a real cure.
As far as I can tell, that is what it does:
> The drug is based on a molecule he discovered while working at Pfizer, and can be delivered via a once-a-month EpiPen-style injection, where it restores protective processes to diseased joints and enables the regeneration of affected tissues. It works by blocking a compound that supports the nerve cells involved in transmitting pain signals to the brain.
This doesn't say it just blocks the pain, it says it directly affects the nerve cells involved in transmitting pain. Those nerve cells could also be responsible for other unpleasant things, like generally complaining and always being inflamed and inhibiting proper healing.
It is hoped the drug — which is not a cure but will make the condition much less painful for sufferers — could also be used to treat rheumatoid arthritis and chemotherapy-induced pain in the future.
As a writer myself who has watched journalism dying, crap articles being written by underpaid freelancers, the enshitification of the internet while everyone objects to any means used to monetize content creation, etc ad nauseum, I don't really feel like trying to figure out just how much this "really does" for patients.
The medical industry in the US tends to be about profit and I think people should, in fact, profit for their work but in medicine sometimes profit motive tosses the baby out with the bathwater. And I'm super burned out on trying to have any kind of meaningful discussion of that issue online.
"not a cure" means that if you stop taking the drug, the condition comes back, at least as far as I can tell. Which checks out given the other information given by the article.
I thought tissue degeneration was part of the issue here? Having regenerated tissue doesn't necessarily help if you stop taking the drug and the tissue just goes away again.
(It sounds weird to me that tissue can just disappear from that area so I think this might be wrong?)
If tissue gets regenerated, it shouldn't "just go away again" once you stop the drug unless perhaps there is an unidentified pathological process involved.
yeah, I too find it weird to imagine that tissue can just disappear from the inside of a joint. where would it even go? does it melt into the bloodstream or something? lmao
Interesting - this looks like Beransa[1] (Librela) which is a monthly injection for canines that have osteoarthritis. My dog did not have any noticeable changes to pain after using this for 2 months so I've decided to take him off of it.
My cat has been in the feline equivalent (Solensia/frunevetmab) for about two years, and although it had a huge positive impact for the first 12 to 18 months, it seems to have suddenly completely stopped working in the last little while.
One theory is that the immune system eventually starts attacking the monoclonal antibody med itself, another is that as in humans, the OA progression might accelerate under the drug.
I also have mine on Pentosan which did have a noticeable difference for him so that's great. You could possibly talk to your vet about this, it's significantly cheaper than Beransa (110AUD/month) and for my dog it's biannual with a booster shot in between
I actually (anecdotally) heard a similar issue with Pentosan that it stops working after 12-24 months due to the immune system so you have to "time it" at an appropriate time in a dog's life. To be blunt, by appropriate I mean you'd want to start using it 12-24 before the dog is expected to pass and not at the first sign of osteoarthritis.
This is the only publication I found in a quick search:
https://pubmed.ncbi.nlm.nih.gov/37976118/
>> Abstract
Objectives: Nerve growth factor β (β-NGF) is a protein which is important to the development of neurons particularly those involved in the transmission of pain and is central to the experience of pain in osteoarthritis (OA). Direct NGF antagonism has been shown to reduce OA pain but is associated with rapidly progressive OA. The aim of the study is to investigate the ability of soluble neurotrophin receptors in the NGF pathway to modulate pain in OA.
Methods: Synovial fluid (SF) was obtained from the knee joints of 43 subjects who underwent total knee arthroplasty. Visual analogue scale (VAS) pain scores were obtained prior to surgery. Customised-automated-ELISAs and commercial-ELISAs and LEGENDplex™ were used to measure soluble low-affinity nerve growth factor (LNGFR), soluble tropomyosin receptor kinase (TrkA), proNGF, β-NGF, other neurotrophins (NT) and cytokines including inflammatory marker TNF-α.
Results: The VAS score positively correlated with β-NGF (r=0.34) and there was positive association trend with neurotrophin-3 (NT-3), BDNF and negative association trend with ProNGF. sLNGFR positively correlated with VAS (r=0.33). The β-NGF/soluble TrkA ratio showed a strong positive correlation with VAS (r=0.80). In contrast, there was no correlation between pain and the β-NGF/sLNGFR ratio (r=-0.08). TNF-α positively correlated with β-NGF (r=0.83), NT-3 (r=0.66), and brain-derived neurotrophic factor (BDNF) (r=0.50) and negatively with ProNGF (r= -0.74) and positively correlated with both soluble TrkA (r=0.62), sLNGFR (r=0.26).
Conclusions: This study suggests that endogenous or cleaved sLNGFR, but not soluble TrkA may participate in OA pain modulation thus supporting further research into soluble LNGFR as a therapeutic target in OA.