Appa compared against Meloxicam in canine OA

      Purpose: APPA is a synergistic combination of 2 antiinflammaory molecules (acetovanillone and paeonol). The trial was designed to test the comparative efficacy of osteoarthritis (OA) treatments in client-owned dogs at week 2 and week 4 against the week 1 untreated baseline. 80 dogs were included in the study diagnosed with naturally occurring osteoarthritis (carpal, elbow, shoulder, hock, stifle, hip) confirmed by radiography. Primary outcomes the dogs were appraised at days 21 and day 35. using (i) Force Plate Analysis (FPA), (ii) 5 point clinical examination by veterinarians, blinded to the treatment groups and (iii) Quality of Life (QoL) questionnaire completed by the owners.
      Methods: The dogs were randomly divided into 4 groups of 20. 1 week run-in with 80 dogs without treatment. The treatments using either APPA (45mg/kg twice daily) or Placebo (45mg/kg twice daily) in groups 1, 2, 3, and 4 was blinded. The administration of Meloxicam (0.1 mg/kg/d) could not be blinded. No other pain medications, including nutraceutical, were administered to any of the dogs for the duration of the study. All dogs receiving Meloxicam also received stomach protection (Famotidine).
      Results: A total of 72 dogs completed the study with 6 drop-outs from the two Metacam groups due to gastrointestinal problems notwithstanding that they were also receiving Famotidine. The mean body mass was 29.45±11.05 kg, the mean age 9.0±3.04 years. A significant placebo effect was never observed at any time point for any measurement. Significant benefits were detected for APPA (P<0.005), Meloxicam (P<0.02) , APPA+Meloxicam (P<0.001) in the orthopaedic examination at days 21 and 35, pain score for APPA (P<0.05) and APPA+Meloxicam (P<0.005) at days 21 and 35, function for APPA (P<0.01) and APPA+Meloxicam (P<0.001) at days 21 and 35, and FPA symmetry index for APPA (P<0.01), Meloxicam (P<0.01) , APPA+Meloxicam (P<0.05) at day 21 and APPA+Meloxicam (P<0.01)at day 35.
      Conclusions: In a previous OA study APPA, in client-owned dogs, normalized gait asymmetry as measured with an objective force plate system (FPA). For ethical reasons this study was not blinded and was not placebo controlled. In contrast this 2nd OA study was blinded with a placebo control group. Using the FPA which only evaluated OA dogs walking at gentle pace in a straight line (1.2m/sec) it was decided to include, concurrent with the FPA, a more detailed and extended range of gait/pain evaluations that would provide a more objective picture of the patient clinical responses to the drug interventions. APPA has demonstrated significantly decreased disease progression in a rat meniscal tear model of OA, but disease progression was not examined in this dog study.