Background:Apocynin and paeonol are secondary metabolites of plants used in traditional Asian medicine for centuries. The combination of synthetic versions of these two molecules (APPA) was developed initially for the treatment of osteoarthritis (OA) in animals where it has been found at least as effective as meloxicam. Human clinical trials are currently ongoing.Objectives:To report the outcomes from a case series of patients treated with APPA.Methods:Subjects with a diagnosis of OA, who had

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... ied unsuccessfully a number of standard therapies, requested treatment with APPA from the author (NL), often following successful treatment of their animals with the combination or via networking. The usual daily dose was 1240 mg paeonol and 352 mg of apocynin taken as two 400mg capsules twice daily.Results:Twenty-three subjects with a diagnosis of OA of whom 7 were scheduled for surgery have been treated with APPA. There were 10 female and 13 males with an age range from 40 to 81 years. Nine patients had OA of the knees, 5 of whom had bilateral involvement, 7 had hip OA, 5 bilaterally and 2 with end stage bone on bone disease. Four patients had hand OA, one of whom also had disease of the hip, lower back and feet. In 3 patients the joints involved was not recorded. In 19 patients treatment was reported as effective. In 4 patients the treatment was ineffective, all of who were scheduled or had been recommended for surgery. In 2 of these cases cases this was bone on bone The duration of treatment for OA at the last recorded follow-up was reported for 16 patients in whom treatment was deemed effective and ranged from 9 to 120 months (median 24 months). In a further 3 patients the treatment the duration was not reported. In the 4 patients where no benefit was reported APPA was discontinued within a few weeks. In no case was there a report of APPA being discontinued due to adverse events. In 13 patients it was specifically stated that there had been no adverse events whereas for the remaining 10 patients it was not documented whether adverse events had occurred or not.Conclusion:Treatment with APPA was reported as effective by 82.6% of patients. In all patients in which the combination was ineffective the disease was severe with joint replacement recommended or scheduled; in two patients this was bone on bone. This would suggest that APPA is not a simple analgesic, a conclusion supported by effects seen in the rat meniscal tear model where possible disease modifying effects have been reported (1).References:[1]Glasson, S., Bendele, A. and Larkins, N. (2012). APPA provides disease modification in preclinical osteoarthritis. Osteoarthritis and Cartilage20: S72 -S73 Abstract 132.Disclosure of Interests:Nicholas Larkins Shareholder of: AKL R and D Ltd, Employee of: AKL R and D Ltd