Pentosan polysulfate sodium (iPPS) is a semi-synthetic drug manufactured from beech-wood hemicellulose by sulfate esterification of the xylopyranose hydroxyl groups. From in vitro and animal model studies, pentosan has been proposed as a disease modifying osteoarthritis drug (DMOAD).
How does it work?
Osteoarthritis (OA) is a widespread and common problem. New research indicates that OA may start as an inflammatory reaction in joints that slowly degrades cartilage causing pain and deformity.
Recent work by Paradigm Biopharma Phase 2b trial of 112 subjects, published in a peer review journal PLoS One, identified a source of the pain mediator Nerve Growth Factor (NGF) on bone cells, and was able to inhibit production of NGF leading to pain reduction. A further 500 patients with OA have been treated under the TGA Special Access Scheme with similar results. It also has anti inflammatory and disease modifying actions that protect cartilage degeneration. Reduced Bone Marrow lesions (BML) at day 53 were reduced in grade, volume and area signalling a possible regression of disease. ( ASX release 15 April 2019)
How is Pentosan administered?
iPPS is administered twice a week for 6 weeks into subcutaneous tissue (usually belly fat). The needles are small and relatively painless. Unlike PRP and Hyaluronic acid, iPPS is not injected into the affected joints and can have widespread effects on other osteoarthritic joints.
Is Pentosan a Steroid?
iPPS is not like cortisone or other injectable corticosteroids. Whilst injectable steroids only have a anti-inflammatory effect and have been shown to cause rapid deterioration of joints (ref 2), IPPS is a disease modifying agent with ongoing research indicating it may delay progression of osteoarthritis,
Sodium pentosan polysulfate resulted in cartilage improvement in knee osteoarthritis - An open clinical trial-Kenji Kumagai, Susumu Shirabe, Noriaki Miyata, Masakazu Murata, Atsushi Yamauchi, Yasuhumi Kataoka, and Masami Niwa BMC Clin Pharmacol. 2010; 10: 7
McAlindon T, LaValley M, Harvey W, et al. Effect of intra-articular triamcinolone vs saline on knee cartilage volume and pain in patients with knee osteoarthritis: a randomized clinical trial. JAMA. 2017;317(19):1967–75.
How can i get Pentosan?
At this stage, Pentosan is not available for sale in Australia. It can only be accessed by application to the Therapeutic Goods Administration (TGA) Special Access Scheme. Dr Ibrahim has successfully treated many patients by this method. If you have been diagnosed with Osteoarthritis and have failed other forms of non surgical treatment, you may be eligible for consideration of the use of Pentosan.
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What are the side effects of Pentosan
iPPS is a FDA approved drug that has a long track record of safely treating inflammation over 60 years. For the purpose of treating osteoarthritis, small bruises may be seen on the abdomen at the injection site and blood markers of prolonged bleeding times may increase for a short time. This treatment is not indicated in patients that are on long term blood thinners.