Abstract
Objective. Background Strontium ranelate is currently used for osteoporosis. The international, double-blind, randomised, placebo-controlled Strontium ranelate Efficacy in Knee OsteoarthrItis triAl evaluated its effect on radiological progression of knee osteoarthritis. Methods. Patients with knee osteoarthritis (Kellgren and Lawrence grade 2 or 3, and joint space width (JSW) 2.5-5 mm) were randomly allocated to strontium ranelate 1 g/day (n=558), 2 g/day (n=566) or placebo (n=559). The primary endpoint was radiographical change in JSW (medial tibiofemoral compartment) over 3 years versus placebo. Secondary endpoints included radiological progression, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and knee pain. The trial is registered (ISRCTN41323372). Results. The intention-to-treat population included 1371 patients. Treatment with strontium ranelate was associated with smaller degradations in JSW than placebo (1 g/day: -0.23 (SD 0.56) mm; 2 g/day: -0.27 (SD 0.63) mm; placebo: -0.37 (SD 0.59) mm); treatment-placebo differences were 0.14 (SE 0.04), 95% CI 0.05 to 0.23, p<0.001 for 1 g/day and 0.10 (SE 0.04), 95% CI 0.02 to 0.19, p=0.018 for 2 g/day. Fewer radiological progressors were observed with strontium ranelate (p<0.001 and p=0.012 for 1 and 2 g/day). There were greater reductions in total WOMAC score (p=0.045), pain subscore (p=0.028), physical function subscore (p=0.099) and knee pain (p=0.065) with strontium ranelate 2 g/day. Strontium ranelate was well tolerated. Conclusions. Treatment with strontium ranelate 1 and 2 g/day is associated with a significant effect on structure in patients with knee osteoarthritis, and a beneficial effect on symptoms for strontium ranelate 2 g/day. Additional supplementary data are published online only. To view these files please visit the journal online (http://dx.doi. org/10.1136/annrheumdis-2012-202231)
Highlights
Osteoarthritis is characterised by degeneration of cartilage and other structures in the joint, including subchondral bone.[1]
Strontium ranelate is currently indicated for the management of postmenopausal osteoporosis, and may be hypothesised to act on both cartilage and subchondral bone
The aim of the 3-year international, double-blind, randomised, placebo-controlled trial—Strontium ranelate Efficacy in Knee OsteoarthrItis triAl (SEKOIA)— described was to evaluate the effect of strontium ranelate on radiological and clinical progression of knee osteoarthritis
Summary
Osteoarthritis is characterised by degeneration of cartilage and other structures in the joint, including subchondral bone.[1]. Strontium ranelate is currently indicated for the management of postmenopausal osteoporosis, and may be hypothesised to act on both cartilage and subchondral bone. Preclinical in vitro studies indicate that it inhibits subchondral bone resorption[4] and stimulates cartilage matrix formation in normal and osteoarthritic human chondrocytes.[5 6] Exploratory analyses suggest that 3 years’ treatment with strontium ranelate attenuates radiological progression of spinal osteoarthritis and improves back pain.[7] The aim of the 3-year international, double-blind, randomised, placebo-controlled trial—Strontium ranelate Efficacy in Knee OsteoarthrItis triAl (SEKOIA)— described was to evaluate the effect of strontium ranelate on radiological and clinical progression of knee osteoarthritis. The international, double-blind, randomised, placebo-controlled Strontium ranelate Efficacy in Knee OsteoarthrItis triAl evaluated its effect on radiological progression of knee osteoarthritis
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