X-ray too non-specific for DMOAD inclusion

Recent article published in the premier OA journal Osteoarthritis and Cartilage by BICL team leaders Drs. Roemer and Guermazi present data from the MOST study analyzing X-ray and MRI findings in Kellgren Lawrence 2 and 3 knees that are commonly considered eligible for inclusion to DMOAD trials.

They found that 20% of KL2 and 6% of KL3 knees do not exhibit any cartilage damage at all in the medial compartment and one third of KL2 knees exhibited only minimal cartilage damage. Thus, these compartments without or only minimal damage are likely not amenable for anabolic cartilage DMOAD effects. On the other hand, about 25% of KL2 and >70% of KL3 knees show widespread medial full-thickness cartilage damage and are likely not ideal candidates for anti-catabolic treatment approaches. Between 20% and 30% of medial compartments exhibited additional bone marrow lesions in the same subregions where cartilage damage occurred, and thus, have to be considered at high risk for progression and may be considered for enrichment of clinical trial populations. As neither cartilage nor BMLs are visualized on X-rays and given the heterogeneity of cartilage damage in KL2 and 3 knees, using only radiography as an instrument to define structural eligibility needs to be reconsidered depending on mode of action of a specific DMOAD compound.

Please find article attached.