beta-escin and Osteoarthritis

Pain is one of the major symptoms of the osteoarthritis (OA). The objective of the study was to evaluate impact of combined therapy with diclofenac, aescin and original glucosamine sulfate on pain severity in patients with OA of different localizations in real life clinical settings in Russia and Ukraine.. Design--prospective, non-controlled, before and after post-marketing study. Study was performed in 38 cities across Russia and Ukraine in 2012. Registered anti-inflammatory and symptomatic slow acting drugs were used according to the registered indications and dosages. In Russian sites combined therapy A using diclofenac ("Dorosan" formulation, Rottapharm S.p.A., aerosole 1%, 3-4 times/day) for two weeks, original glucosamine sulfate ("Dona" formulation, Rottapharm S.p.A.) intramuscular (ampule 200 mg/ml, 2 ml 3 times/week) for 4 weeks and per os (powder 1500 mg, once/day) for 8 weeks was used. In Ukraine sites (scheme B) diclofenac was substituted with topical aescin ("Reparil-Gel" formulation, Madaus AG, tube 400 mg, 2-3 times/day) anti-inflammatory product. Physicians were free to change therapy and study organizers had no impact on prescribing and management practice. Patients with OA of different localizations were included into the study. Pain severity was assessed using numeric rating scale. Total duration of the study was 8 weeks. Questionnaires were distributed to patients via physician out-patient offices. The only endpoint was the difference in median pain severity at the end of the study compared with the baseline level.. In total 4931 patients were included into the study (mean age 57 +/- 12 years, 75% were females). Scheme A was used in 3956 patients and scheme B in 975 patients. The median pain severity decreased from 0.7 at the baseline (interquartile range +/- 0.2) to 0.2 (interquartile range +/- 0.2) after 8 weeks of the study in both treatment regimens (p < 0.001). Limitations of the study include absence of the control group, collection of the questionnaires from physician offices, rather than directly from patients, limited range of clinical data collected and use of single instrument to assess pain severity.. Post-marketing study of combined therapy of OA of different localizations using diclofenac, aescin and original glucosamine sulfate in Russia and Ukraine demonstrated decrease of the pain severity, assessed by numeric rating scale, after 8 weeks of the treatment.

Topics: Aged; Anti-Inflammatory Agents; Cardiovascular Agents; Diclofenac; Drug Therapy, Combination; Escin; Female; Glucosamine; Humans; Male; Middle Aged; Osteoarthritis; Pain; Pain Measurement; Prospective Studies; Russia; Treatment Outcome; Ukraine

Osteoarthritis (OA) is a chronic degenerative joint disease with inflammatory component. It is associated with progressive histological alterations and disabling symptoms. Today, drugs such as glucocorticoids (GCs) and nonsteroidal anti-inflammatory drugs (NSIADs) are commonly employed for treatment of osteoarthritis, but have serious and life-threatening side effects. The aim of the current study is to evaluate the effects of escin on cyclooxygenase-2 (COX-2, isoform), inducible nitric oxide synthase (iNOS), interleukin-1β (IL-1β), interleukin-18 (IL-18), tumor necrosis factor-alpha (TNF-α), and nitric oxide (NO) (1), as well as prostaglandin E2 (PGE2) on inflammatory cells, similar osteoarthritis in synoviocytes, and monocytes/macrophages, and to compare it with dexamethasone (DEX) and ibuprofen (IBP). Synovial cells were isolated from synovial membrane of the radiocarpal joint cartilage of an 8-month-old Holstein cow. THP-1 cells were prepared from Pasteur Institute of Iran. Cells were cultivated and exposed to lipopolysaccharide (LPS) stimulation without, or in the presence of, DEX, IBP, or escin. The gene expressions of IL-1β, TNF-α, IL-18, COX-2, and iNOS were evaluated by real-time PCR. Concentrations of NO and PGE2 were measured by ELISA methods. Our cells secreted an increased amounts of IL-1β, TNF-α, IL-18, COX-2, iNOS, NO, and PGE2 in response to LPS stimulation in all conditions. Escin can quench the gene expression of COX-2, iNOS, IL-1β, IL-18, and TNF-α in synoviocyte cells and production of NO and PGE2 in monocyte/macrophage cells alike DEX and IBP. We can use from escin for the treatment of osteoarthritis as an anti-inflammatory agent in the latter but further studies to support the results from such a model are needed.

Topics: Animals; Anti-Inflammatory Agents; Cattle; Cyclooxygenase 2; Dexamethasone; Dinoprostone; Escin; Female; Humans; Ibuprofen; In Vitro Techniques; Infant; Interleukin-1; Interleukin-1beta; Iran; Nitric Oxide; Nitric Oxide Synthase Type II; Osteoarthritis; Polyphenols; Synoviocytes; Tumor Necrosis Factor-alpha