Efficacy and safety of strontium ranelate in the treatment of knee osteoarthritis: results of a double-blind, randomised placebo-controlled trial

Reginster, J.Y., Badurski, J., Bellamy, N., Bensen, W., Chapurlat, R., Chevalier, X., Christiansen, C., Genant, H., Navarro, F., Nasonov, E., Sambrook, P.N., Spector, T.D. and Cooper, C. (2013) Efficacy and safety of strontium ranelate in the treatment of knee osteoarthritis: results of a double-blind, randomised placebo-controlled trial. Annals of the Rheumatic Diseases, 72 (2), 179-186. (doi:10.1136/annrheumdis-2012-202231). (PMID:23117245)

Abstract

Background Strontium ranelate is currently used for osteoporosis. The international, double-blind, randomised, placebo-controlled Strontium ranelate Efficacy in Knee OsteoarthrItis triAl evaluated its effect on radiological progression of knee osteoarthritis.

Methods Patients with knee osteoarthritis (Kellgren and Lawrence grade 2 or 3, and joint space width (JSW) 2.5–5?mm) were randomly allocated to strontium ranelate 1?g/day (n=558), 2?g/day (n=566) or placebo (n=559). The primary endpoint was radiographical change in JSW (medial tibiofemoral compartment) over 3?years versus placebo. Secondary endpoints included radiological progression, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and knee pain. The trial is registered (ISRCTN41323372).

Results The intention-to-treat population included 1371 patients. Treatment with strontium ranelate was associated with smaller degradations in JSW than placebo (1?g/day: ?0.23 (SD 0.56) mm; 2?g/day: ?0.27 (SD 0.63) mm; placebo: ?0.37 (SD 0.59) mm); treatment-placebo differences were 0.14 (SE 0.04), 95% CI 0.05 to 0.23, p<0.001 for 1?g/day and 0.10 (SE 0.04), 95% CI 0.02 to 0.19, p=0.018 for 2?g/day. Fewer radiological progressors were observed with strontium ranelate (p<0.001 and p=0.012 for 1 and 2?g/day). There were greater reductions in total WOMAC score (p=0.045), pain subscore (p=0.028), physical function subscore (p=0.099) and knee pain (p=0.065) with strontium ranelate 2?g/day. Strontium ranelate was well tolerated.

Conclusions Treatment with strontium ranelate 1 and 2?g/day is associated with a significant effect on structure in patients with knee osteoarthritis, and a beneficial effect on symptoms for strontium ranelate 2?g/day.

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Contributors

Author: C. Cooper

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