LAUSR

The prevalence of osteoarthritis (OA) and the burden associated with the disease are steadily increasing worldwide, representing a major public health challenge for the coming decades. The lack of specific treatments for OA has led to it being recognized as a serious disease that has an unmet medical need. Advances in the understanding of OA pathophysiology have enabled the identification of a variety of potential therapeutic targets involved in the structural progression of OA, some of which are promising and under clinical investigation in randomized controlled trials. Emerging therapies include those targeting matrix-degrading proteases or senescent chondrocytes, promoting cartilage repair or limiting bone remodelling, local low-grade inflammation or Wnt signalling. In addition to these potentially disease-modifying OA drugs (DMOADs), several targets are being explored for the treatment of OA-related pain, such as nerve growth factor inhibitors. The results of these studies are expected to considerably reshape the landscape of OA management over the next few years. This Review describes the pathophysiological processes targeted by emerging therapies for OA, along with relevant clinical data and discussion of the main challenges for the further development of these therapies, to provide context for the latest advances in the field of pharmaceutical therapies for OA. In this Review, the authors describe the pathophysiological targets and clinical effects of new drugs currently being investigated for the treatment of osteoarthritis. Osteoarthritis (OA) is a very common and severely debilitating disease with an unmet medical need, and new drugs are needed to alleviate OA symptoms and/or prevent structural progression. Several drugs, such as sprifermin and MIV-711, have been shown to prevent cartilage loss or protect subchondral bone in OA, and thus represent potential disease-modifying OA drugs (DMOADs). The clinical benefits of the positive structural outcomes observed with DMOADs, as well as their long-term safety, remain unclear. Nerve growth factor inhibitors (such as tanezumab and fasinumab) improve pain and function in severe knee or hip OA, but are associated with an increased risk of rapidly progressive OA. Biologic drugs (including IL-1β and TNF inhibitors) and bisphosphonates have yielded disappointing results in OA. The clinical heterogeneity of OA is one of the major challenges for the development of DMOADs, as different phenotypes could require specific therapeutics. Osteoarthritis (OA) is a very common and severely debilitating disease with an unmet medical need, and new drugs are needed to alleviate OA symptoms and/or prevent structural progression. Several drugs, such as sprifermin and MIV-711, have been shown to prevent cartilage loss or protect subchondral bone in OA, and thus represent potential disease-modifying OA drugs (DMOADs). The clinical benefits of the positive structural outcomes observed with DMOADs, as well as their long-term safety, remain unclear. Nerve growth factor inhibitors (such as tanezumab and fasinumab) improve pain and function in severe knee or hip OA, but are associated with an increased risk of rapidly progressive OA. Biologic drugs (including IL-1β and TNF inhibitors) and bisphosphonates have yielded disappointing results in OA. The clinical heterogeneity of OA is one of the major challenges for the development of DMOADs, as different phenotypes could require specific therapeutics.