Anti-inflammatory Drug May Help Osteoarthritis Patients Avoid Joint Replacement

hip replacement x-ray

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Key Takeaways

  • Over 10% of people over age 60 develop osteoarthritis in the United States.
  • There is currently no definitive treatment for osteoarthritis; patients typically resort to hip and knee replacement surgeries.
  • Canakinumab, an anti-inflammatory drug, is a potential nonsurgical treatment.

Osteoarthritis (OA) is the most common joint disorder in the United States. Although healthcare providers can prescribe drugs to relieve pain, there is currently no definitive treatment for OA. People with osteoarthritis typically need to undergo hip or knee replacement surgery—which can be both costly and painful.

However, a new study conducted by the CANTOS (Canakinumab Anti-inflammatory Thrombosis Outcomes Study) trial group suggests de facto OA joint replacements could soon become a thing of the past thanks to a drug called canakinumab. The drug is typically used to treat certain rare rheumatic conditions marked by widespread inflammation. But researchers found that the use of the canakinumab reduced the need for hip and knee replacements by over 40% in study participants, irrespective of dose.

In their paper, which was published in Annals of Internal Medicine on August 4, the researchers examined the impact of canakinumab on OA over a span of five years. But the study participants—all men—weren't recruited for an osteoarthritis study.

This research began with a 2017 study focused on the role of canakinumab in heart disease. Researchers noticed the drug reduced the risk of heart attack and stroke by lowering C-reactive protein levels. High levels of C-reactive protein are linked to osteoarthritis. And so, a second study began.

While the preliminary results are encouraging, more research is needed before the drug can be developed into an osteoarthritis treatment.

What This Means For You

Over 32 million adults in the U.S. have osteoarthritis, which can cause immobility, intense pain, and reduced quality of life. Currently, the only medically-recognized treatment is surgery. If treatment with canakinumab is approved, it would give patients with osteoarthritis an affordable, nonsurgical treatment option that doesn’t involve months of rehab.

Potential Uses for Canakinumab

The preliminary CANTOS trial, published in 2017 in The New England Journal of Medicine, included 10,061 men who were given a 50 milligram (mg), 150 mg, or 300 mg injection of either canakinumab or a placebo control every three months for five years. The followup study tracked hospital trips for surgery among participants, including joint surgery. That's when the potential link to osteoarthritis became clear: the incidence rate for hip and knee replacements decreased by 40% and 47%, respectively, in patients who received canakinumab.

What Is Canakinumab?

Canakinumab is a laboratory-made antibody that binds to interleukin-1 proteins, which are associated with autoimmune disease and inflammation. Canakinumab (brand name Ilaris) is mainly used to treat inflammatory fever syndromes and asthma.

Despite these encouraging results, researchers say the study has its drawbacks. The CANTOS trial was conducted on an exclusively male and a predominantly diabetic group. Therefore, anti-arthritic benefits cannot automatically be extrapolated to women.

“Previous smaller trials have not shown benefits from anti-interleukin-1 therapy,” Philip Conaghan, MD, one of the lead researchers in the CANTOS trial, tells Verywell. Additional research is needed to find out why the CANTOS trial was different.

Conaghan says scientists have found new applications for canakinumab in other diseases as well.

“It’s also used to treat uncommon autoimmune diseases, such as Stills disease, and highly-resistant gout,” he says.

Can Doctors Start Prescribing Canakinumab For OA?

Conaghan says it’s still too early to recommend canakinumab as a treatment for osteoarthritis.

Canakinumab may lower the immune system's ability to fight off infection, something that's an especially big risk during a global pandemic.

“Even though canakinumab could prove to be beneficial, the risks are too high right now,” Giuseppe Aragona, MD, medical advisor at Prescription Doctor, tells Verywell. Aragona was not involved in the CANTOS study.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Clin Geriatr Med. 2010;26(3):355-69. doi:10.1016/j.cger.2010.03.001

  2. Schieker M, Conaghan PG, Mindeholm L, Praestgaard J, Solomon D, Scotti C.  Effects of interleukin-1β inhibition on incident hip and knee replacementAnnals of Internal Medicine. doi:10.7326/M20-0527

  3. D'Onofrio K. Canakinumab may be able to slow down the progression of OA, reduce joint replacement risk. docwirenews.

  4. Centers for Disease Control and Prevention. Osteoarthritis (OA).

  5. U.S. National Library of Medicine—Clinical Trials. Cardiovascular risk reduction study (Reduction in recurrent major CV disease events)(NCT01327846).

  6. Dhimolea E. Canakinumab. MAbs. 2010;2(1):3-13. doi:10.4161/mabs.2.1.10328