GLP-1RA ‘might be disease-modifying’ in knee osteoarthritis with type 2 diabetes
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Key takeaways:
- Patients receiving glucagon-like peptide-1 receptor agonists lost more weight and had fewer knee surgeries.
- Further investigation is needed to determine the therapy’s effects on OA disease process and joint structure.
Glucagon-like peptide-1 receptor agonists “might be disease-modifying” in patients with knee osteoarthritis and type 2 diabetes if treatment is sustained for a sufficient period, according to data.
The researchers, who published their findings in the Annals of the Rheumatic Diseases, added that the result may be mediated by weight loss.
“Sustaining weight control in the long term remains a major challenge for the general population including [knee OA (KOA)] patients,” Hongyi Zhu, PhD, of the department of orthopedics at Shanghai Sixth People’s Hospital, in China, and colleagues wrote. “Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are a class of medications that are effective treatment for patients with type 2 diabetes mellitus (T2DM) and weight control by stimulating insulin secretion, suppressing glucagon secretion, delaying gastric emptying and decreasing appetite.”
To investigate whether GLP-1RAs might have a positive impact in patients with knee OA, Zhu and colleagues analyzed data from a prospective, observational, multicenter study called the Shanghai Osteoarthritis Cohort. The researchers identified all patients with knee OA and type 2 diabetes mellitus enrolled in the cohort between Jan. 1, 2011, and Jan. 1, 2017. Patients were included if they had baseline bilateral pain radiographs demonstrating Kellgren and Lawrence grades of 1 to 3, as well as at least 2 years of follow-up before the initiation of GLP-1RA therapy — for the sake of comparisons between groups. Patients were excluded if they had K-L grades of 0 or 4, diabetic vascular disease, secondary OA or a history of diabetic foot or knee surgery.
Participants reported their own characteristics, including age, sex and weight at baseline. Incident knee surgery was defined as any surgical procedure intended to alleviate knee OA symptoms after study enrollment.
The analysis included 1,807 patients with knee OA and comorbid type 2 diabetes mellitus. According to Zhu and colleagues, patients who received GLP-1RA therapy lost more weight (average = –7.29 kg; 95% CI, –8.07 to –6.5) and were less likely to undergo surgery for knee OA (P = .014). In addition, there were statistically significant differences in pain scores (adjusted mean difference in WOMAC total score = –1.46; 95% CI, –2.84 to –0.08) and cartilage-loss velocity (adjusted mean difference = –0.02mm; 95%CI, –0.03 to –0.002). When comparing before and after values, the researchers found that patients who received GLP-1RA therapy consumed less medication for their symptoms — at 0.03 ± 0.05 mm per year after treatment vs. 0.05 ± 0.07 (P < .001).
In addition, compared with the non-GLP-1RA group, the researchers reported a “substantially” lower incidence of knee surgery among those who received the treatment — 5.9% vs 1.7% (P = .014).
“With sufficient treatment duration, GLP-1RA therapies might be disease-modifying for KOA patients with comorbid T2DM,” Zhu and colleagues wrote. “Further investigations are needed to elucidate the effects of GLP-1RA on the disease process, joint structure and [patient reported outcomes] of OA.”
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