Pill may reduce need for knee, hip replacements

Also: Alzheimer’s research at record high; AI ‘virtual therapy’ for depression

New pill may help prevent knee and hip replacements

A new study is suggesting that a low dose of colchicine may be associated with lower incidences of both total knee replacement and total hip replacement surgeries. The analysis, published in Annals of Internal Medicine, suggests this might be a simple and safe way of lowering the risks for knee and hip replacements.

Osteoarthritis is an increasingly common joint disease that can be associated with low-grade inflammation in response to weight-bearing traumatic injury. Previous studies have demonstrated an association between the use of anti-inflammatory therapies and the slowing of osteoarthritis disease progression. Colchicine is effective in many inflammatory and fibrotic conditions, but it is not currently recommended for treatment of osteoarthritis. Its long-term effects have also not been assessed.

Researchers from the Netherlands examined whether colchicine reduced incident total knee replacements and total hip replacements. In the study, 5,522 participants age 35 to 82 from 43 centers in Australia and the Netherlands received 0.5 mg of colchicine daily or matching placebo. The participants were followed for more than two years (28.6 months).

The authors found that 2.5% of persons receiving colchicine had total knee replacement or total hip replacement compared with 3.5% of persons who received placebo. The observations support the hypothesis that inflammation plays a role in the progression of osteoarthritis. Colchicine has been widely used to treat other diseases and is generally considered to have a favorable safety profile. This makes it a good candidate for treatment of osteoarthritis.

Colchicine is used to prevent or treat attacks of gout (also called gouty arthritis). This condition is caused by too much uric acid in the blood. An attack of gout occurs when uric acid causes inflammation (pain, redness, swelling and heat) in a joint. Colchicine does not cure gout, but it will help prevent gout attacks.

Promising new treatments for Alzheimer’s disease

The annual Alzheimer’s Disease drug development pipeline report for this year is providing a good reason for optimism. According to the “Alzheimer’s Disease Drug Development Pipeline: 2023,” there are currently 187 clinical trials in the Alzheimer’s drug development pipeline. This is the most ever on record. This momentum is driven in part by greater investment from the pharma industry and a bump in biologic therapies, particularly monoclonal antibodies.

The annual report, published in Alzheimer’s & Dementia: Translational Research and Clinical Interventions, was led by Dr. Jeffrey Cummings, a leading Alzheimer’s clinician-scientist and research professor at University of Nevada School of Integrated Health Sciences. The goal of the annual report is to spot trends in clinical trial design and outcome measures, and also investigate the types of agents and biological targets that are being pursued.

“Our database has gotten stronger and our ability to draw analysis from the pipeline is ever better,” said Dr. Cummings, who first began the annual pipeline project in 2016. “We can derive lessons from both positive and negative trials that will inform and accelerate the development of new treatments.”

More than 6 million Americans are living with Alzheimer’s disease, a staggering number that’s expected to double within the next 30 years. Recently, the FDA approved Aduhelm (aducanumab) and Leqsebi (lecanemab) to treat early-stage symptoms of the disease. These are the first-ever disease-modifying therapies (DMTs) to earn the green light for use against Alzheimer’s.

Researchers identified data from all current phase 1, 2 and 3 clinical drug trials for Alzheimer’s Disease and Mild Cognitive Impairment as of Jan. 1, 2023. The team tracked all therapies in the pipeline, the types of agents used, and how far along each is in the drug development process. The researchers also analyzed the agencies and industries funding clinical trials.

They found 58 new drugs have entered the pipeline in the past year and DMTs are the most common agents used in trials. Approximately 28% of candidate therapies are repurposed from other diseases.

“We are at an inflection point in the Alzheimer’s field,” said Maria C. Carrillo, who is the chief science officer at the Alzheimer’s Association. “The recent landmark FDA approvals we’ve seen for both disease-modifying and symptomatic treatments, as well as the diversification of the pipeline of potential new Alzheimer’s therapies, provide hope to those impacted by this devastating disease.”

Improving mental health with artificial intelligence

An artificial intelligence (AI) voice coach is showing promise for treating depression and anxiety treatment. Researchers at the University of Illinois Chicago (UIC) tested an AI voice-based virtual coach for behavioral therapy and they found changes in patients’ brain activity along with improved depression and anxiety symptoms. This was all thanks to Lumen, an AI voice assistant that delivered a form of psychotherapy.

The team says the results, which are published in the journal Translational Psychiatry, offer encouraging evidence that virtual therapy can play a role in filling the gaps in mental health care.

“We’ve had an incredible explosion of need, especially in the wake of COVID, with soaring rates of anxiety and depression and not enough practitioners,” said Dr. Olusola A. Ajilore, who is a professor of psychiatry at UIC. “This kind of technology may serve as a bridge. It’s not meant to be a replacement for traditional therapy, but it may be an important stop-gap before somebody can seek treatment.”

The researchers recruited more than 60 patients with mild-to-moderate depression and anxiety symptoms. Two-thirds of the patients used Lumen on an iPad for eight problem-solving therapy sessions.

After the intervention, study participants using the Lumen app showed decreased scores for depression, anxiety and psychological distress compared with the control group. The Lumen group also showed improvements in problem-solving skills that correlated with increased activity in the dorsolateral prefrontal cortex, a brain area associated with cognitive control.

It’s about changing the way people think about problems and how to address them, and not being emotionally overwhelmed, according to the researchers. They stress that the virtual coach doesn’t need to perform better than a human therapist to fill a desperate need in the mental health system.

John Schieszer is an award-winning national journalist and radio and podcast broadcaster of The Medical Minute. He can be reached at medicalminutes@gmail.com.

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John Schieszer is an award-winning national journalist and radio and podcast broadcaster of The Medical Minute.

  • Email: medicalminutes@gmail.com

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