# Disease-modifying osteoarthritis drug

A disease-modifying osteoarthritis drug (DMOAD) is a disease-modifying drug that would inhibit or even reverse the progression of osteoarthritis. Since the main hallmark of osteoarthritis is cartilage loss, a typical DMOAD would prevent the loss of cartilage and potentially regenerate it. Other DMOADs may attempt to help repair adjacent tissues by reducing inflammation. A successful DMOAD would be expected to show an improvement in patient pain and function with an improvement of the health of the joint tissues.

## Approved for human use

There are currently no DMOADs approved for human use.

## Drugs with undergoing human trials

| Drug | Mechanism of Action | Status | Investigator(s) |
| TPX-100 (Matrix Extracellular Phosphoglycoprotein) | 23-amino acid peptide that induces articular cartilage formation reduces pathological shape change of joint bones. | In 2021, OrthoTrophix, the developer of the drug, reported that a one-year study of 93 patients suggested that TPX-100 treatment was associated with significant and sustained improvements in critical knee functions, preservation of knee cartilage thickness, reduced pathologic changes in the underlying bone, and a >60% decrease in the use of pain medications. In late 2023, the company licensed TPX-100 to American Reagent in the US for an undisclosed amount. | Orthotrophix American Reagent |
| AKL4 / APPA | Oral NFkB and Nrf2 modulator | National Institute for Health Research (NIHR)-approved Phase I study completed 1Q 2020. Phase 2 150-patient started 4Q 2020 with NBCD (Nordic Bioscience) and is due to complete 3Q 2021. | AKL Research & Development |
| SM04690 / Lorecivivint | Wnt pathway inhibitor | Phase 2 study was completed, and pain, function, and joint space width improvement were observed. Phase 3 study started in May 2019. In May 2020, it was reported that the phase 2a trial failed to meet the primary endpoint. But a phase 2b trial in early 2021 met the primary endpoint. BioSplice(ex-Samumed) expects to release phase 3 results in late 2021. | Biosplice Therapeutics |
| KA34 / Kartogenin | Induces MSCs to differentiate into chondrocytes via its lytic product 4-aminobiphenyl (known as a carcinogen) | Phase 1 study started in May 2018 to evaluate safety of kartogenin in humans. | Calibr |
| UBX0101 (Senolytic agents) | p53/MDM2 inhibitor, induces apoptosis of senescent cells to create a favourable healing environment | Phase 1 study complete in June 2019, results were encouraging leading to plans for a phase 2 study. Phase 2 study results showed no improvements, which led to the drug being discontinued from the investigation. | Unity Biotechnology |
| BMP7(Bone Morphogenetic Protein 7) | Supports transcription of osteogenic genes | Phase 1 study completed in 2010. Phase 2 study completed in 2015, with the company claiming that the data suggested the ability to prevent cartilage loss. As of 2024, the Ember Therapeutics website is down, and Google indicates that the company is permanently closed. | Ember Therapeutics |
| FGF-18 / Sprifermin | Promote chondrogenesis through fibroblast growth factor receptor FGFR3 | Phase 2 study completed in 2017 and 5 year follow-up published in 2021, demonstrated clear dose- and frequency-dependent improvements in cartilage thickness (primary endpoint), complete arrest in progression to joint replacement (in the high dose treatment groups), and improvements in the WOMAC pain survey for high-risk patients (secondary endpoint). Subsequent analysis additionally demonstrated statistically significant and clinically meaningful improvements in WOMAC progression for the high-dose treatment groups relative to placebo. | Formation Bio Merck Nordic Bioscience |
| LNA043 | Chondrogenesis enhancer | Phase 1 study started in 2015. | Novartis |
| GLPG1972 (Proteinases Inhibitors) | ADAMTS-5 inhibitor | Phase 1 study completed in 2019. Phase 2 study started in 2019. In October 2020, Servier reported phase 2 trial failed. | Galapagos |
| M6495 | ADAMTS-5 inhibitor | Phase 1 safety study completed. | Novartis |
| MIV-711 (Cathepsin K inhibitors) | Cathepsin K inhibitor | Phase 2 study completed in 2019 showed the prevention of cartilage damage but did not show a reduction in patient pain. | Medivir |
| Invossa-K (Transforming Growth Factor- β) | Cell/Gene therapy | Human studies halted by FDA for false ingredient claim. There are claims FDA allowed for phase 3 trials to resume in the US. As of January 2022, phase 3 clinical trial has resumed in the US. | Kolon Life Science |
| Amniotic fluid allograft (ReNU, Palingen InovoFlo, AmnioFix, Clarix Flo) | Note: Amniotic fluid is not a single drug and instead contains around 226 growth factors, including BMP7. Inflammation reducer and cartilage growth enhancer. | The initial six patient studies in 2015 showed improved pain and function. A randomised controlled trial of 200 patients completed in 2019, also showing improved pain and function. A 2019 non-randomized study of 20 patients showed improvement in joint tissue health. | Organogenesis Amnio Technology MiMedx Amniox Medical, Inc. |
| Polysulfate Sodium (PPS) | Pentosan Polysulfate Sodium (PPS) is a semi-synthetic drug manufactured from European beech xylans that are sulfated to produce a negatively charged product that mimics glycosaminoglycans (GAGs). | Paradigm's IND application to commence its phase 3 pivotal clinical trial investigating Pentosan Polysulphate Sodium (PPS) for the treatment of pain associated with knee osteoarthritis has been cleared by the US FDA. Approximately 65 sites have been identified throughout the US and Australia. Contracting with many of those sites has been completed. The first four sites in Australia have initiated screening participants. Screening at the US sites is expected to begin before the end of CY2021. The Company is now in a position to accelerate recruitment by adding approximately 10 sites in the United Kingdom (UK) and Europe, with site initiation and subject screening expected to commence in 1H CY 2022. | Paradigm Biopharmaceuticals (ASX:PAR) |

## Drugs under investigation

| Drug | Mechanism of Action | Status | Investigator(s) |
| A2M | Protect chondrocytes from damage | A2M inhibited catabolic activity in rats. Note: Cytonics offers autologous A2M therapy in humans but no randomised human trials have been published to date. A human trial is underway at NYU. | Cytonics |
| SS-31 | Mitoprotective peptide | Study done on two horses showed protective effects in vivo. | Cornell |
| TD-198946 | Chondrogenic factor | Basic science studies being carried out. | University of Tokyo |
| M6495 | ADAMTS-5 inhibitor | Shown to protect against cartilage breakdown in cartilage and synovial joint tissue explant models | Merck |
| B001-5 | ADAMTS-5 and ADAM-17 inhibitor | To be submitted to the FDA in early 2020. | Guangzhou Institutes of Biomedicine and Health |
Gene therapy for osteoarthritis is also being investigated as technology to create a drug that would act as a disease-modifying drug. Several approved drugs are being investigated as repurposed agents in the treatment of osteoarthritis such as liraglutide (anti-diabetic and anti-obesity drug: NCT02905864), Metformin (anti-diabetic drug: NCT04767841, NCT05034029), Zoledronic acid (anti-osteoporotic drug: NCT04303026), etc.
Paroxetine has been deemed to have DMOAD activity.