This summer, experts from academia, industry and regulatory sectors gathered in Reykjavik, Iceland for The International Workshop on Osteoarthritis Imaging (IWOAI) to discuss the latest advances related to imaging in Osteoarthritis (OA). Presentations at this conference centered on new imaging techniques and analytical methods for monitoring OA pathophysiology and evaluating imaging data from clinical studies.
Several members of BioClinica’s musculoskeletal team attended the workshop and presented data on new semi-automated software tools for measuring radiographic joint features including joint space width (JSW) of the knee and hip. These tools have the potential to help improve the precision of joint measurements in clinical trials, facilitating enrollment and evaluation of disease modifying treatments for OA.
I recently sat down with Hui Jing Yu, PhD, Medical Affairs Scientist at BioClinica, to talk about medical imaging in OA clinical trials and her experience at IWOAI. Here’s what she had to say.
Why did you attend The International Workshop on Osteoarthritis Imaging?
The IWOAI represents a great opportunity for OA experts from academic and industry sectors to gather and discuss the latest advances in imaging in OA. With a vested interest in OA clinical trials, BioClinica sponsored and sent several members of its musculoskeletal team to this workshop. My colleagues and I presented several posters and gave a talk summarizing recent work on semi-automated software tools for analyzing imaging data in OA clinical trials.
Can you elaborate on these tools and their utility for advancing OA clinical trials?
Radiographic features of the joint remain important criteria for evaluating subject eligibility in trials and as endpoints for disease modifying therapies. Controlled image acquisition combined with semi-automated software tools maximizes measurement precision for OA endpoints clinical trial outcomes. BioClinica’s proprietary software provides reliable measurements of minimum JSW of the knee and hip with greater speed and precision than manual measurements and with good intra- and inter-reader agreement. These tools can also be used to measure knee malalignment, identifying unsuitable candidates for trials. Overall, these tools have the potential to improve OA clinical trial outcome measurements.
Can you talk a little bit about advances in imaging techniques related to OA?
Technological advances in medical imaging are providing new tools and endpoint capabilities for diagnosing and assessing OA disease progression. For example, today’s high resolution scanners enable quantitative analysis of bone structure using Quantitative Computed Tomography (QCT). My colleague Dr. Klaus Engelke gave a talk on advanced knee structure analysis for determining cartilage and subchondral bone structure at various locations across the knee. In addition, this year’s OA meeting featured several presentations highlighting the application of imaging technology for monitoring OA and assessing new disease modifying drugs. Dr. John Carrino highlighted the application of MRI advances including high field strength MRI and ultrashort echo MRI in OA assessment. These advances provide compositional changes for detecting pathology beyond morphologic depiction of pathoanatomy, transcending the limitations of conventional MRI.
What are researchers in the OA imaging community striving to achieve?
The use of MRI based continues to grow for OA trials. Although MRI provides benefits over conventional radiography (e.g. superior validity and responsiveness), there are still questions and concerns from regulatory agencies regarding its clinical application for longitudinal studies. Several ongoing studies are aimed at addressing these concerns and synthesizing clinical findings across clinical trials (pooling and comparing data from different trial designs and cohorts). In addition, The OA imaging community is currently working to develop standardized approaches to aggregating MRI clinical trial data.
What's next for imaging in OA trials?
One exciting area is the ongoing effort to develop anti-nerve growth factor (NGF) agents for the treatment of chronic pain associated with OA. Although NGF agents demonstrate significant pain reduction in clinical trials, there are concerns regarding the bone safety of such treatments. Previous studies involving NGF treatments relied on imaging endpoints for diagnosis/prognosis (to inform trial eligibility), but not for monitoring clinical outcomes. Future studies will be aimed at incorporating increasingly thorough evaluations of images of the major articulating joints to screen out subjects with preexisting subchondral insufficiency fractures (SIF) and osteonecrosis conditions. This combinatorial use of imaging will be highly critical for evaluating the safety and efficacy of NGF treatments in future OA trials.
More information on BioClinica’s semi-automated OA tools >>
More information on imaging core lab services for OA trials >>