Triamcinolone Acetonide Extended-Release: A Review in Osteoarthritis Pain of the Knee

Paik, Julia; Duggan, Sean T.; Keam, Susan J.

doi:10.1007/s40265-019-01083-3

Cited by 92 publications

(77 citation statements)

References 31 publications

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“…For instance, an FDA-approved formulation Zilretta Ò utilizes the size properties of microspheres to enable greater retention in the joint and extended release treatment of the active ingredient from within the microsphere for arthritis treatment after intra-articular injection. 49 However, nanomaterials may be more beneficial than micron-sized carriers when utilizing passive targeting strategies. For instance, the smaller sizes of nanomaterials enable them to penetrate barriers in tissues such as the cartilage and localize intracellularly.…”

Section: Drug Delivery Systems That Leverage Charge For Delivery To Tmentioning

confidence: 99%

Leveraging Electrostatic Interactions for Drug Delivery to the Joint

Kumar

2020

Bioelectricity

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Arthritis is a debilitating joint disease with a high economic burden and prevalence. There are many challenges delivering therapeutics to the joint, including low bioavailability when administered systemically and low joint retention after intra-articular injection. Therefore, drug delivery systems such as nanoparticles, liposomes, dendrimers, and carrier proteins have been utilized to overcome some of these limitations. To enhance joint tissue localization and retention, there are opportunities to leverage electrostatic interactions between drug carriers and various tissues and cells. These opportunities, as they pertain to specific joint tissues, are explored in this review. Further, the impact that electrostatic interactions has on various drug delivery parameters, such as the formation of a protein corona, the uptake and cytotoxicity, and the biodistribution of the drug delivery systems, is discussed. Lastly, this review summarizes key findings from studies that have investigated the use of electrostatic interactions to increase targeting of specific joint tissues and limitations in preclinical investigations are identified. As more novel targets are discovered in treating arthritis, there will be a continued need to localize therapeutics to specific tissues for greater therapeutic outcomes and hence attention must be paid in designing the drug delivery systems.

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Section: Drug Delivery Systems That Leverage Charge For Delivery To Tmentioning

confidence: 99%

Leveraging Electrostatic Interactions for Drug Delivery to the Joint

Kumar

2020

Bioelectricity

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“…These studies have also shown the combination of all three drugs is more effective than any drug alone or pair of two drugs, that TRI MP can confine drug activity to a local area resulting in antigen-specific immunosuppression, and that sustained release of drug from TRI MP is more potent than equivalent unencapsulated doses. Furthermore, injection of microparticles into inflamed joints could be a viable clinical approach as intra-articular injection of corticosteroid containing microparticles is already FDA-approved for osteoarthritis pain management [ 56 ].…”

Section: Introductionmentioning

confidence: 99%

TRI microparticles prevent inflammatory arthritis in a collagen-induced arthritis model

et al. 2020

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Despite recent progress in the treatment of rheumatoid arthritis (RA), many patients still fail to achieve remission or low disease activity. An imbalance between auto-reactive effector T cells (Teff) and regulatory T cells (Treg) may contribute to joint inflammation and damage in RA. Therefore, restoring this balance is a promising approach for the treatment of inflammatory arthritis. Accordingly, our group has previously shown that the combination of TGF-βreleasing microparticles (MP), rapamycin-releasing MP, and IL-2-releasing MP (TRI MP) can effectively increase the ratio of Tregs to Teff in vivo and provide disease protection in several preclinical models. In this study TRI MP was evaluated in the collagen-induced arthritis (CIA) model. Although this formulation has been tested previously in models of destructive inflammation and transplantation, this is the first model of autoimmunity for which this therapy has been applied. In this context, TRI MP effectively reduced arthritis incidence, the severity of arthritis scores, and bone erosion. The proposed mechanism of action includes not only reducing CD4 + T cell proliferation, but also expanding a regulatory population in the periphery soon after TRI MP administration. These changes were reflected in the CD4 + T cell population that infiltrated the paws at the onset of arthritis and were associated with a reduction of immune infiltrate and inflammatory myeloid cells in the paws. TRI MP administration also reduced the titer of collagen antibodies, however the contribution of this reduced titer to disease protection remains uncertain since there was no correlation between collagen antibody titer and arthritis score.

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“…This nested case-control study provides new and novel information on the safety of IACI on the evolution of knee structural changes in OA individuals, a topic of clinical interest in view of previous reports [10][11][12][13][14]27,28 in which controversy still exists regarding possible deleterious effects on joint structure. Data in this study demonstrated that a single IACI in knee OA was safe with no negative impact on articular structural changes, as no differences between the control and IACI groups were found for cartilage volume change, bone curvature, and BML in the evolution of the structural changes post-treatment.…”

Section: Discussionmentioning

confidence: 96%

“…Although several studies have explored the efficacy of IACI to treat knee OA symptoms and the extent and length of response to a single treatment, meta-analysis indicated that the clinical benefit of an IACI after one to six weeks was unclear 8 . Recent clinical trials, however, suggested that repeated treatment with an extended-release formulation of triamcinolone acetonide significantly prolongs and amplifies the symptomatic benefit with no deleterious effect on joint structure when assessed by X-rays 10,11 . In a recent review 12 , it was however, suggested that this particular issue about the safety of IACI remains to be determined until examined more closely.…”

mentioning

confidence: 99%

Intra-articular corticosteroid knee injection induces a reduction in meniscal thickness with no treatment effect on cartilage volume: a case–control study

Pelletier

Raynauld

Abram³

et al. 2020

Sci Rep

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Although intra-articular corticosteroid injections (iAci) are commonly used for the treatment of knee osteoarthritis (OA), there is controversy regarding possible deleterious effects on joint structure. In this line, this study investigates the effects of IACI on the evolution of knee OA structural changes and pain. Participants for this nested case-control study were from the Osteoarthritis Initiative. Knees of participants who had received an iAci and had magnetic resonance images (MRi) were named cases (n = 93), and each matched with one control (n = 93). Features assessed at the yearly visits and their changes within the follow-up period were from MRi (cartilage volume, meniscal thickness, bone marrow lesions, bone curvature, and synovial effusion size), X-ray (joint space width), and clinical (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] pain score) data. Participants who received IACI experienced a transient and significantly greater rate of loss of the meniscal thickness (p = 0.006) and joint space width (p = 0.011) in the knee medial compartment in the year they received the injection, compared to controls. No significant effect of the IACI was found on the rate of cartilage loss nor on any other knee structural changes or WOMAC pain post-treatment. in conclusion, a single iAci in knee oA was shown to be safe with no negative impact on structural changes, but there was a transient meniscal thickness reduction, a phenomenon for which the clinical relevance is at present unknown.

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Triamcinolone Acetonide Extended-Release: A Review in Osteoarthritis Pain of the Knee

Cited by 92 publications

References 31 publications

Leveraging Electrostatic Interactions for Drug Delivery to the Joint

Leveraging Electrostatic Interactions for Drug Delivery to the Joint

TRI microparticles prevent inflammatory arthritis in a collagen-induced arthritis model

Intra-articular corticosteroid knee injection induces a reduction in meniscal thickness with no treatment effect on cartilage volume: a case–control study

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