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Off-label drug for hand osteoarthritis treatment offers no benefit

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A drug that is used as an off-label treatment for osteoarthritis of the hand may not be effective, according to new research.

Doctors sometimes prescribe hydroxychloroquine for pain relief in patients with hand osteoarthritis when conventional medication has failed.

The drug is not specifically licensed for this condition but is used by some doctors as an alternative to paracetamol, non-steroidal anti-inflammatory drugs or opioids.

Lead researcher Dr Sarah Kingsbury, from the University of Leeds and the NIHR Leeds Biomedical Research Centre at Chapel Allerton Hospital, said: “There is some scientific basis as to why hydroxychloroquine could be an effective drug agent.

“It is known to target inflammation in the joints and is a recognised and licensed treatment for rheumatoid arthritis.

“There is increasing evidence that inflammation is a factor in osteoarthritis. So doctors have used hydroxychloroquine off-label, in a way that it was not licensed for, to try and control symptoms and pain.”

Until now, no large-scale studies have looked at whether using hydroxychloroquine works in this patient group.

The latest research, published in the journal Annals of Internal Medicine, involved 248 hand osteoarthritis patients at 13 NHS hospitals in England. All participants had changes to the joints in their hands consistent with osteoarthritis, and all reported moderate to severe pain on at least half of the days in the previous three months.

Patients who received hydroxychloroquine initially reported a small reduction in the severity of pain, but this improvement plateaued and any benefits were no greater than in the group taking the placebo.

Measurements of grip strength and the structural damage in patients’ joints were also similar for both groups.

“Our findings do not support the current medical practice of giving hydroxychloroquine to patients with hand osteoarthritis,” Dr Kingsbury concluded.

Up to 31% of people over the age of 70 are estimated to suffer from osteoarthritis in the hands.

http://www.leeds.ac.uk/news/article/4187/study_challenges_use_of_off-label_drug_to_treat_osteoarthritis_in_hands

http://www.arthritisresearchuk.org/news/general-news/2018/february/new-study-demonstrates-no-benefit-to-off-label-hand-osteoarthritis-therapy.aspx

http://annals.org/aim/article-abstract/2672940/hydroxychloroquine-effectiveness-reducing-symptoms-hand-osteoarthritis-randomized-trial?doi=10.7326%2fM17-1430