Year: 2023
Type: conference-abstract
Abstract: Background Depression is common in patients with knee OA, and clinical guidelines do not advise treating both conditions simultaneously. However, recent research recommends combining interventions that address symptoms of both conditions to maximize efficacy. Exercise improves pain, disability, and mood, but chronic pain and depression are barriers to physical activity in this population. Duloxetine is indicated to treat neuropathic pain and depression among knee OA patients and could serve as a therapeutic complement to exercise. Objectives To assess the feasibility of a 24-week, center-based, aerobic exercise program, plus duloxetine to treat knee OA and depression. Methods Participants were recruited between August 2021 and November 2022 from the University of Maryland and VA Maryland Health Care Systems and study advertisements. Inclusion criteria were: English speaking; age 40 years or older; symptomatic knee OA satisfying ACR criteria; major depression according to the SCID-5 (Structured Clinical Interview for DSM-V, ruling out history of bipolar disorder or psychotic symptoms; substance abuse disorder or suicidal ideation in the last year); no plans for knee surgery; and ability to walk on a treadmill. Exclusions included: exercising at least twice per week; taking duloxetine, antipsychotics, benzodiazepines, or opioid analgesics; cognitive impairment; comorbidity precluding exercise; and pregnant or lactating women. Participants began duloxetine (30 mg/day) as they started exercising, titrating up to a daily optimal dose of 60 mg/day. They were expected to complete 3 supervised treadmill walking sessions per week based on an individualized training plan defined by peak heart rate achieved during a graded exercise test. Data were collected at baseline and 12- and 24-weeks. Feasibility was evaluated via recruitment rates, reasons for drop out, and treatment adherence. Depression and pain severity were measured using the Hamilton Depression Rating Scale (HAM-D) and Knee Injury and Osteoarthritis Outcome Score (KOOS) pain subscale, respectively. Results Among 377 interested adults, 98 completed telephone pre-screening (Figure 1). Common reasons for not pre-screening included time commitment (n=39), no depression (n=27), concerns about medication (n=25), already on antidepressants (n=20), and knee surgery (n=12). There were 68 ineligible prescreened individuals who did not satisfy criteria for probable depression (n=45), medications (n=16), knee OA symptoms (n=5), or exercise (n=2). The 30 eligible candidates were invited to in-person screening visits, but 21 did not attend, and only 9 were enrolled. These 9 participants were older women (mean age=64.7 years), 8 identified as Black/African American, 7 attended and/or graduated from college, 3 were married, and 4 were retired. During the in-person screening process, 6 participants did not satisfy DSM-V criteria for major depression, 1 voluntarily withdrew from the study, and only 2 satisfied all eligibility criteria. One participant withdrew at baseline due to a non-study related adverse event and another completed the treatment protocol. The participant who completed the study was almost 100% adherent to duloxetine and experienced a reduction in depression severity from baseline to 24 weeks (HAM-D=25 to 1). By contrast, exercise compliance was low, with only 26% of planned sessions completed, and knee pain severity changed little from baseline (KOOS=41.7 to 44.4). Conclusion Treating knee OA and depression with a center-based exercise program and duloxetine had low feasibility. Critical design challenges amenable to change included the time commitment of 3 weekly supervised exercise sessions among interested individuals and depressive symptoms not satisfying diagnostic criteria for major depression for persons who wanted treatment. A hybrid or home-based exercise program plus duloxetine may be more feasible, and knee OA patients with depressive symptoms who are at risk for major depression could benefit from preventive intervention. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests Alan Rathbun: None declared, Rhea Mehta: None declared, Alice Ryan: None declared, Yu Dong: None declared, Brock Beamer: None declared, Justine Golden: None declared, Joseph Gallo: None declared, Mark Luborsky: None declared, Michelle Shardell: None declared, Jason Peer: None declared, Marc Hochberg Consultant of: Marc Hochberg is the president of Rheumcon and receives consulting fees from Bone Therapeutics, Bristol-Myers Squibb, Eli Lilly, Galapagos, IBSA Insititut Biotechniq SA, Novartis Pharma AG, Pfizer, Samumed LLC, Theralogix LLC and Kolon TissueGene.
Authors: A. Rathbun, R. Mehta, A. Ryan, Y. Dong, B. Beamer, J. Golden, J. Gallo, M. Luborsky, M. Shardell, J. Peer, M. Hochberg
Language: English
Subfield: Pharmacology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
OpenAlex ID: W4379522396