Background/Purpose: Chronic musculoskeletal pain can be a significant source of disability and poor quality of life in adults. Many patients do not achieve adequate relief with standard treatments, highlighting the need for novel therapies. Nerve growth factor (NGF), released by pro-inflammatory cells, is crucial in pain signalling, with elevated levels found in chronic pain patients. Fasinumab is a selective nerve-growth factor inhibitor that has shown efficacy in managing musculoskeletal disorders such as osteoarthritis (OA) and chronic low back pain (CLBP).

Methods: We conducted a systematic search in PubMed, Scopus, Embase, Web of Science, ClinicalTrials.gov, and Cochrane through April 25, 2025. Eligible studies were randomized clinical trials (RCTs) comparing the efficacy of Fasinumab against placebo or other analgesics in treating chronic musculoskeletal pain. Two independent reviewers completed screening and data extraction for each study. Primary efficacy outcomes were pooled mean difference from baseline to endpoint for pain levels, represented either as Western Ontario and McMaster Universities Arthritis (WOMAC) index or low back pain intensity (LBPI) numeric rating score, and physical function represented as either WOMAC index or Roland Morris Disability Questionnaire (RMDQ) score. The secondary outcome was pooled change from baseline for Patient Global Assessment (PGA). We used a random-effect model for all the analyses conducted. Outcomes were reported as standardized mean difference (SMD) with a 95% confidence interval (CI).

Results: A total of eight RCTs (12118 patients) met the inclusion criteria, comprising seven OA and one CLBP trial. Two trials included NSAIDs as a comparator. The pooled analysis for Fasinumab against placebo indicated statistically significant pain reduction and physical function improvement; SMD (95%CI) = -0.38 (-0.45: -0.3), p< 0.001, and -0.41 (-0.48: -0.33), p< 0.001, respectively. The pooled mean difference against NSAIDs regarding pain level and physical function was statistically significant; SMD (95%) = -0.19 (-0.29: -0.09), p< 0.001, and -0.21 (-0.3: -0.12), p< 0.001, respectively. Additionally, PGA improvement was statistically significant against placebo and NSAIDs; SMD = -0.25 (-0.33: -0.17), p< 0.001, and -0.11 (-0.2: -0.02), p=0.02, respectively.

Conclusion: This meta-analysis shows that Fasinumab has promising results in managing chronic musculoskeletal pain and suggests it may be superior to placebo or conventional analgesics. Further studies involving more intervention arms are needed to come up with a more definitive answer.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/efficacy-of-fasinumab-an-anti-nerve-growth-factor-monoclonal-antibody-in-managing-chronic-musculoskeletal-pain-a-systematic-review-and-meta-analysis/