Predicting Response to Osteoarthritis Treatment Based on Patient Reported Outcome Measures and Quantitative Sensory Testing

Kristine Phillips¹, David A. Williams², Arnold Gammaitoni³, J. Ryan Scott⁴, Steven E. Harte⁴, Susan L. Murphy⁵ and Daniel J. Clauw⁶, ¹Internal Medicine, University of Michigan, Ann Arbor, MI, ²Anesthseiology, University of Michigan, Ann Arbor, MI, ³Zogenix, Inc, San Diego, CA, ⁴Department of Anesthesiology, University of Michigan, Ann Arbor, MI, ⁵Phyiscal Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI, ⁶Anesthesiology, University of Michigan, Ann Arbor, MI

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Comparative effectiveness and harms, osteoarthritis and pain management

Session Information

Date: Monday, November 9, 2015

Title: Pain: Basic and Clinical Aspects Poster

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose:

Recent studies have suggested that a subset of individuals with arthritis have a component of sensitization to their pain. This subset of patients with centralized pain can theoretically be identified via self -report measures, quantitative sensory testing, or a combination of the two. This study examined whether phenotyping patients by self-report or QST measures of pain centralization predicted a differential response amongst OA patients to a centrally-acting (duloxetine) vs. peripherally-acting (topical diclofenac) analgesic, or both together.

Methods:

Fifty-two subjects meeting ACR criteria for osteoarthritis of the knee were enrolled in a double-blind crossover trial where each was treated with 20 mg of duloxetine or four times daily 1.5% topical diclofenac solution. Assessments included WOMAC, PainDETECT, Pain Quality Assessment Scale (PQAS), PROMIS physical function Short Form, Pressure Pain Threshold, and Conditioned Pain Modulation. Subjects were treated for eight weeks in a counter-balanced fashion, followed by a four-week washout period, and then another eight weeks of treatment. A subset of individuals entered a third treatment period of combined duloxetine and diclofenac. The primary endpoint was a change in the WOMAC pain subscale at eight weeks.

Results:

Treatment with duloxetine resulted in a significant decrease in WOMAC pain subscale whereas there was no significant improvement in the group means in the 1.5% diclofenac treatment period. Patient reported outcome measures predicted response to duloxetine, including total scores on PainDETECT and PQAS Intensity subscale. QST assessment for baseline pressure pain threshold predicted the response to duloxetine based on change in WOMAC pain subscale, but there was no association between QST measures of conditioned pain modulation and response to duloxetine. An increase in the PainDETECT score was associated with an increase in pain as measured by the WOMAC pain subscale by an average of 0.22 per unit increase in pain DETECT score (SE 0.059, p=0.0005). There were no differences in adverse events or rescue medication usage between the arms.

Conclusion:

PainDETECT, PQAS, and Pressure Pain Threshold predict response to duloxetine. Pain control in this cohort was most favorable for duloxetine alone or in combination with topical diclofenac.

Disclosure: K. Phillips, None; D. A. Williams, Health Focus Inc., 5; A. Gammaitoni, None; J. R. Scott, None; S. E. Harte, MAST Device, 4,Cerephex, 5,Analgesic Solutions, 5,Merck, 5,Regeneron, 5,deCode Genetics, 5; S. L. Murphy, None; D. J. Clauw, Abbott Laboratories, 5,Cerephex, 5,Eli Lilly and Company, 5,Forrest Laboratories, 5,Johnson & Johnson, 5,Merck Pharmaceuticals, 5,Pfizer Inc, 5,Purdue Pharma L.P., 5,Samumed, 5,Theravance, 5,Tonix, 5,UCB, 5,Zynerba, 5,Abbott Laboratories, 5,Cerephex, 5,Eli Lilly and Company, 5,Forest Laboratories, 5,Johnson & Johnson, 5,Merck Pharmaceuticals, 5,Pfizer Inc, 6,Purdue Pharma L.P., 6,Samumed, 5,Theravance, 5,Tonix, 5,UCB, 5,Zynerba, 5.

To cite this abstract in AMA style:

Phillips K, Williams DA, Gammaitoni A, Scott JR, Harte SE, Murphy SL, Clauw DJ. Predicting Response to Osteoarthritis Treatment Based on Patient Reported Outcome Measures and Quantitative Sensory Testing [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/predicting-response-to-osteoarthritis-treatment-based-on-patient-reported-outcome-measures-and-quantitative-sensory-testing/. Accessed .

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