Glycosaminoglycan-peptide complex: data on the mechanism of action and efficacy in osteoarthritis

Abstract

The article presents the modern definition of osteoarthritis (OA) not as a degenerative cartilage injury, but as a disease in which abnormal adaptive regenerative processes are activated, including pro-inflammatory pathways of the immune system, based on the clarification of the pathogenesis of the disease. An approach to the separation of various OA phenotypes is described. Various approaches to the tactics of pharmacological treatment of the disease are presented. The possibilities of the glycosaminoglycan-peptide complex to influence the state of chondrocytes and cartilage tissue in various experimental models of induced OA are described. And in the last experimental study, a positive effect of the drug on the clinical manifestations of 2 models of induced OA was demonstrated, a decrease in the concentration of CRP, interleukin 1β was recorded with  an increase in the concentration of anti-inflammatory cytokines (interleukins 4 and 10), a significant decrease in the number of leukocytes in the synovial fluid, as well as a decrease in pathological changes in cartilage during histological examination, which it indicates that the drug exerts its effect directly in the tissues of the joint. Clinical studies have confirmed the analgesic and anti-inflammatory activity of the glycosaminoglycan-peptide complex in OA, although not all conducted in the twentieth century, the positive effect on joint pain and joint function was significantly better than placebo. The absence in these years of regulated criteria for inclusion in studies of the effectiveness of pharmacological drugs in OA, the introduction of new methods for assessing pain, function served as a prerequisite for conducting studies of the effectiveness and tolerability of the glycosaminoglycan-peptide complex at the present stage. Multicenter observational studies, which included massive groups of patients with OA of various localization, confirmed the presence of analgesic and anti-inflammatory activity in the drug, manifested during the 1st course of injections, showed that repeated courses of drug administration are necessary to achieve a more pronounced and stable effect. Data on an increase in the effect of combination therapy with diacerein and on the possibility of achieving an effect in patients with previous insufficient efficacy of other slow-acting symptomatic drugs are presented.