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Are biologics a treatment option in osteoarthritis?

Xavier Chevalier and Fernando Kemta-Lepka

This article examines biologics as emerging therapies for osteoarthritis. There are currently no disease‑modifying antiosteoarthritis drugs. IL‑1b and TNF‑a are two major cytokines produced by the synovial cells and the chondrocytes that are involved in cartilage matrix destruction. Inhibition of these two proinflammatory cytokines appears logical in osteoarthritis (OA). There is sound evidence based on in vivo animal models of OA, to support the use of cytokine inhibitors in human clinical trials. The route of administration would preferentially be intra-articular for large joints, such as the knee, and systemic for polyarticular OA, such as hand OA. Two randomized placebo-controlled trials in knee OA, one using intra-articular injection of the antagonist of IL‑1 and another using systemic administration of an antibody against IL‑1, were negative. Results with TNF‑a blockers in hand OA are promising. Biologics will probably be introduced into the treatment armamentarium for OA. However, first, we need to demonstrate their efficacy and then better define to which patient and when biologics should be administered during the course of the disease.