Off-Label Drug Lends No Helping Hand for Osteoarthritis


A recent study dashes hopes for an effective treatment of refractory pain.

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An off-label drug prescribed to treat osteoarthritis of the hand when conventional medication has failed is ineffective, according to new research. The study shows there was no benefit in taking hydroxychloroquine to control debilitating pain when compared with a placebo.

Lead researcher Dr Sarah Kingsbury, from the University of Leeds in the UK, 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 recognized and licensed treatment for rheumatoid arthritis.

"There is increasing evidence that inflammation is a factor in osteoarthritis. So doctors have used hydroxychloroquine off-label to try and control symptoms and pain.

"But until now, there has not been a large-scale study into whether using hydroxychloroquine works. And our evidence shows that for most patients, it is not an effective treatment."

Dr Kingsbury and fellow researchers recently published the results of their study in the Annals of Internal Medicine.

The study
The study involved 248 patients at 13 NHS hospitals in England: all had the condition for at least 5 years and had changes to the joints in their hands consistent with osteoarthritis.

The participants all reported moderate to severe pain on at least half of the days in the previous 3 months to the study commencing.

The results
The study found that patients initially reported a small reduction in the severity of pain before the improvement plateaued. However, that change was seen in both the group receiving the medication and the group taking the placebo.

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

Take-home message for clinicians
Dr Kingsbury said: "Our findings do not support the current medical practice of giving hydroxychloroquine to patients with hand osteoarthritis."


Kingsbury SR, Tharmanathan P, Keding A, et al. Hydroxychloroquine effectiveness in reducing symptoms of hand osteoarthritis: a randomized trial. Ann Intern Med. 2018 Feb 20. doi: 10.7326/M17-1430. [Epub ahead of print]

Study challenges use of off-label drug to treat osteoarthritis in hands [press release]. Leeds, England: University of Leeds; February 19, 2018.

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