Blood Thinner Could Prevent Osteoarthritis

Researchers writing in the current issue of Arthritis and Rheumatology report that a blood thinner may have potential as a preventive treatment for osteoarthritis.

Ticagrelor (Brilinta, AstraZeneca) is a P2Y12 platelet inhibitor currently used to prevent stroke and heart attack in patients with acute coronary syndrome or a history of myocardial infarction. It works by increasing the presence of extracellular adenosine which, in turn, regulates the inflammatory processes. Studies in animal models have shown that it is effective in treating osteoarthritis.

In this study, researchers compared the results in patients who were treated with ticagrelor and a second group who was treated with the blood thinner clopidogrel, which does not increase extracellular adenosine concentrations. This was a five-year study that included 7,007 patients who were treated with ticagrelor for an average of 287 days and 14,014 were treated with clopidogrel for an average of 284 days. The study excluded patients with an osteoarthritis diagnosis at baseline. The average patient was 64 years old and most, at 73 percent, were male. Researchers concluded that patients who were treated with ticagrelor had a 29 percent reduced risk of osteoarthritis (estimated a hazard ratio of 0.71 (95% CI 0.64-0.79, p<0.001).

“These findings suggest that extracellular adenosine may play an important role in reducing cartilage inflammation and damage, and that it might serve as a therapeutic target for preventing and treating osteoarthritis in humans,” wrote researchers who were led by Matthew C. Baker, M.D., of Stanford University. “We believe that even this relatively short treatment period may provide protection against developing osteoarthritis over the subsequent years. It is not clear how long this effect may last, as the follow-up period for this study ended at five years, with a relatively small number of patients at risk after three years.”

Osteoarthritis affects about 27 million adults in the United States. It was once thought of merely as degeneration of the joints, but today is more often recognized as “a disease driven by low-grade inflammation and complex interactions between genes and the environment,” Dr. Baker and colleagues wrote. “There are no effective treatments to prevent the onset or progression of osteoarthritis, and novel therapies are needed.”

REFERENCE

Matthew C. Baker, Yingjie Weng, Robinson H. William, Neera Ahuja, Nidhi Rohatgi. “Osteoarthritis risk is reduced after treatment with ticagrelor compared to clopidogrel: a propensity score matching analysis,” Arthritis and Rheumatology. First Published: 21 June 2020