Intra-articular injection of triamcinolone acetonide extended-release (TA-ER) may be an effective corticosteroid treatment with minimal blood glucose disruption in patients with knee osteoarthritis (OA) and comorbid type 2 diabetes, according to study data published in Rheumatology.
In a double-blind parallel group study (ClinicalTrials.gov identifier: NCT02762370), investigators randomly assigned 33 patients with knee OA and type 2 diabetes (T2D) to treatment with TA-ER (n=18) or standard triamcinolone acetonide crystalline suspension (TAcs) (n=15). Both treatments were administered with intra-articular injection of 32 mg (5 mL) and 40 mg (1 mL) for TA-ER and TAcs, respectively. Continuous glucose monitoring-measured glucose (CGMG) was performed at 1 week pre-injection through 2 weeks post-injection. Change in average daily CGMC from baseline to 1 to 3 days post-injection was captured in each patient as a primary outcome measure. Participants were ≥40 years who had experienced symptomatic knee OA for 6 months or more. Comorbid T2D had been present in patients for at least 1 year prior to screening.
The baseline to post-injection CGMG change was significantly lower in patients who received TA-ER compared with patients who received TAcs (14.7 vs. 33.9 mg/dL; P =.0452). In addition, a greater percentage of patients who received TA-ER (63.3%) had CGMG levels within target glycemic range in the 1 to 3 days post-injection compared with patients who received TAcs (49.7%). The percentage of patients with CGMG >180 mg/dL was also lower in the TA-ER group (34.5%) than in the TAcs group (49.9%). Non-glycemic adverse events were mild and of comparable frequency in both treatment groups.
These data suggest that TA-ER may be an effective treatment for symptomatic knee OA without introducing blood glucose complications. Clinicians may find these findings useful in mitigating blood glucose disruptions during the treatment of symptomatic knee OA.
Russell SJ, Sala R, Conaghan PG. Triamcinolone acetonide extended-release in patients with osteoarthritis and type 2 diabetes: a randomized, phase 2 study [published online September 6, 2018]. Rheumatology. doi:10.1093/rheumatology/key265