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Combination of two anti-inflammatory molecules-Apocynin and Paeonol does not markedly improve symptoms of knee OA. But, it demonstrates the potential for patients with nociplastic pain (also called central sensitization).
A recent randomized clinical trial issued in the Osteoarthritis and Cartilage journal revealed the effectiveness of the fixed-dose oral combination of Apocynin and Paeonol (800 mg) in people with symptomatic knee osteoarthritis (OA) used for over 28 days. While the treatment did not show a striking overall symptom improvement than the placebo, it was well-tolerated with no major safety concerns.
Apocynin and Paeonol are small phenolic compounds known for their extensive anti-inflammatory and immunoregulatory properties. This phase 2a trial by Asger R Bihlet et al. involved 152 participants with radiographic knee OA (Kellgren-Lawrence, KL, grades 2-3) and moderate to severe pain Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain subscale= ≥40/100. One hundred and forty-eight people finished the study. No notable discrepancies in primary outcomes like WOMAC pain, function, or total scores were observed with the combination therapy.
Nevertheless, post hoc analyses showed that individuals with pain characteristics related to nociplastic or neuropathic conditions experienced significant benefits from Apocynin and Paeonol combination. Adverse events, mostly gastrointestinal, were mild to moderate. These findings suggest that combination therapy may offer potential for specific subgroups, especially those with severe or complex pain profiles. Additional research is required to scour its effectiveness in these targeted populations.
Osteoarthritis and Cartilage
The efficacy and safety of a fixed-dose combination of Apocynin and Paeonol, APPA, in symptomatic knee OA: A double-blind, randomized, placebo-controlled, clinical trial
Asger R Bihlet et al.
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