Table 3 Therapies that may be useful in treating FD pain
From: Pathophysiology and medical treatment of pain in fibrous dysplasia of bone
CURRENT AND POTENTIAL THERAPIES FOR TREATMENT OF FIBROUS DYSPLASIA PAIN | |||
|---|---|---|---|
DRUG CLASS | TARGET | ACTION | POTENTIAL COMPLICATIONS |
Current therapies | |||
Biphosphonates | Osteoclasts | Osteoclast apoptosis | Inhibition of bone remodeling/ |
Osteoclast activity suppression | growth Osteonecrosis | ||
Opioids | CNS neurons | Stimulates opioid receptors | Sedation Dependence Constipation |
NSAIDS | Prostaglandin synthesis | Blockade of peripheral and central sensitization | GI toxicity Cardiotoxicity Nephrotoxicity |
Recently approved therapies/ ongoing clinical trials for treating other skeletal pain states | |||
Denosumab (OPG) | Blocks RANKL | Blocks osteoclast activation | Inhibition of bone remodeling/ |
(Amgen) | growth Osteonecrosis | ||
Tanezumab (anti-NGF) (Pfizer) | NGF/TrkA pathway | Blockade of peripheral sensitization Blockade of nerve sprouting | Developing sensory and sympathetic nerve fibers |
Potential therapies | |||
NGF/TrkA inhibitors (Array, JNJ, Abbott) | NGF/TrkA pathway | Blockade of peripheral sensitization Blockade of pH sensitive neurons | Developing sensory and sympathetic nerve fibers |
TRPV1 antagonists (Pfizer, JNJ, Abbott, Merck, GSK, etc.) | TRPV1 channel | Blockade of pH sensitive neurons | Hyperthermia (transient?) |
CSFR1 inhibitors response (Plexxikon, Roche, JNJ) | Inhibition of CSFR1 | Reduction in osteoclasts, macrophages, etc. | Decreased immune response to infection |
Pregabalin (Pfizer) | Calcium channel, α2, δ1 subunit | Aberrant neuronal discharge | Lethargy Drowsiness |