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Pentosan - A Disease Modifying Osteoarthritis Drug

  • April 19, 2017 1:50 PM EDT

    In a recent Specialty Update titled "A Joint Effort - Supplements and Dietary Management of Osteoarthritis," Dr. Donna Raditic briefly discusses the use and consideration of pentosan in the osteoarthritic patient.

    Although this drug is not commercially available, it can be obtained through a compounding pharmacist. We reached out to the experts at Diamondback Drugs for additional information about this drug. Here is information they provided:

    Pentosan polysulphate (PPS) is a polysulfated polysaccharide with a structure similar to heparin. Derived from beech tree wood, it exhibits anti-inflammatory, anticoagulant, and fibrinolytic properties.1 Its primary use in veterinary medicine is for the management of chronic osteoarthritis in canines and horses.2,3 Pentosan polysulphate’s action in preventing disease progression and curbing the symptoms of osteoarthritis is multifactorial. Its disease-modifying effects are a result of its ability to preserve cartilage by increasing cartilage synthesis while inhibiting its breakdown. Additionally, it promotes the continued synthesis of synovial fluid, a key lubricant in moving joints. Its anti-inflammatory action is a result of its ability to decrease complement activation by the body’s immune system and prevent the mobilization of cytokines (inflammatory chemicals) at the joint. The anticoagulant and fibrinolytic properties of PPS improve blood flow to the joint by clearing blood clots and lipid deposits and preventing the formation of new blood clots in the joint by increasing the threshold for platelet activation.1

    In canines, PPS is a non-conventional strategy in the medical management of chronic osteoarthritis, being used either alone or with other modalities such as joint surgery.2,4 Therapy is generally well tolerated, with only a small percentage of canines experiencing side effects that include vomiting and anorexia.2,5 The usual dosage of PPS is a subcutaneous or intramuscular injection given once a week for four weeks.5 After 4 weeks, the canine should be re-evaluated for comfort level and disease progression. 2,4

    PPS can also be used in the prophylaxis and treatment of osteoarthritis in horses as well. In horses, PPS is the backbone to a conservative management strategy,3 and can be used to help prevent osteoarthritis in active horses.6 As in dogs, PPS is given as an intramuscular injection once weekly for four weeks,3,5 although there is evidence to support intra-articular injections.7 The most common side effect seen in horses is an elevation of Prothrombin Time (PTT) in the first 24 hours after administration, and horses who have undergone intra-articular injections should rest for at least 24 hours post-injection and be monitored for intra-articular bleeding.3,5

    References

    1. Ghosh P. The pathobiology of osteoarthritis and the rationale for the use of pentosan polysulfate for its treatment. Semin Arthritis Rheum. 1999 Feb;28(4):211-67.
    2. Pettitt RA, German AJ Investigation and management of canine osteoarthritis In Practice 2015;37:1-8.
    3. McIlwraith CW, Frisbie DD, Kawcak CE. Evaluation of intramuscularly administered sodium pentosan polysulfate for treatment of experimentally induced osteoarthritis in horses. Am J Vet Res. 2012 May;73(5):628-33.