Triamcinolone Acetonide Extended-Release: A Review in Osteoarthritis Pain of the Knee
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ADIS DRUG EVALUATION
Triamcinolone Acetonide Extended‑Release: A Review in Osteoarthritis Pain of the Knee Julia Paik1 · Sean T. Duggan1 · Susan J. Keam1
© Springer Nature Switzerland AG 2019
Abstract Triamcinolone acetonide extended-release (ER) 32 mg (Zilretta®) is approved in the USA for the management of osteoarthritis (OA) pain of the knee and is administered as a single, 5 mL intra-articular (IA) injection. Although the therapeutic effects from IA corticosteroids are typically short-lived, triamcinolone acetonide ER is formulated in poly (lactic-co-glycolic acid) (PLGA) microspheres that slowly release triamcinolone acetonide in the synovium, enabling their prolonged presence in the joint. This reduces systemic exposure and lessens corticosteroid-related systemic adverse reactions, such as blood glucose elevations. In a 24-week, randomized, phase III clinical trial, triamcinolone acetonide ER 32 mg significantly improved mean average daily pain intensity in patients with knee OA relative to placebo, and pain, stiffness and physical function (according to WOMAC criteria) relative to placebo and triamcinolone acetonide crystalline suspension (CS). Triamcinolone acetonide ER was generally well tolerated, with a tolerability profile similar to that of triamcinolone acetonide CS and placebo. Findings from a single-arm phase IIIb study indicated that a repeat administration of triamcinolone acetonide ER may be similarly efficacious to an initial injection without having deleterious effects on cartilage or other aspects of joint structure. Thus, triamcinolone acetonide ER expands the treatment options available for the management of OA pain of the knee.
Triamcinolone acetonide ER: clinical considerations in OA pain of the knee Allows prolonged synovial presence and lower systemic absorption of triamcinolone acetonide Associated with significantly lower blood glucose elevations than triamcinolone acetonide CS Significantly improves pain in patients with knee OA Generally well tolerated
The manuscript was reviewed by: H. S. B. Baraf, Center for Rheumatology and Bone Research, Arthritis and Rheumatism Associates, Wheaton, MD, USA; S. R. Kingsbury, Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Leeds Biomedical Research Centre, University of Leeds, Leeds, UK. * Julia Paik [email protected] 1
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1 Introduction Accounting for most of the total global burden of osteoarthritis (OA) [1], knee OA has become increasingly prevalent with growing obesity rates and the aging population [2]. Pain from knee OA is highly debilitating, with underlying consequences being the impact of pain on mobility, mood and sleep [3]. A positive correlation has also been found between the severity of walking disability from OA and a risk of death (mostly attributed to cardiovascular disease) [2, 4]. Current evidence suggests that synovial inflammation plays a significant role in the pathophysiology of knee OA, making the synovium a key target for tr
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