Bioactive concentrate from small marine fish: The path from safety and efficacy analysis to clinical recommendations

A comprehensive, multimodal, patient-centered approach to the treatment of osteoarthritis (OA) using non-pharmacological and pharmacological treatments can significantly improve the disease course and outcomes. Pathogenetically based introduction of new drugs and medications into therapy, as well as expanded indications for well-studied and safe medications, allow for an expanded arsenal of medications for the treatment of OA. Extensive experience has been accumulated over more than 30 years using preparations containing bioactive small marine fish concentrate (SMFC). In the Russian Register of Medicines (RLS), injectable SMFCs are included in the clinical-pharmacological group of tissue reparation stimulators of natural origin and are classified as “bone and cartilage metabolism correctors” or “other drugs for the treatment of musculoskeletal diseases”. SMFCs are intended to reduce pain and achieve a structure-modifying effect with long-term use. Intramuscular and intraarticular administration of CMMRs increase bioavailability, reduce the frequency of drug administration, and ensure a rapid onset of effect. Thanks to the high-quality evidence accumulated during clinical trials investigating the safety and efficacy of CMMRs for knee, hip, and small joint OA, as well as nonspecific low back pain (NLP), it became possible to include CMMRs in the Clinical Guidelines for Polyarthrosis (Generalized Osteoarthritis), approved in late 2025 and valid through 2027. This article provides a brief overview of the key clinical studies that served as the rationale for including CMMRs in the clinical guidelines, as well as key materials on a recently registered Russian drug from the CMMR group. A literature search was conducted in eLibrary.ru for the period from 2020 to 2025. The search string included “CMMR” or trade names of drugs present in the abstract, article title, keywords, or full text of the publication, with the requirement that the full text of the article be available on eLibrary.ru. A total of 98 references were identified, including six duplicates in both lists. Analysis of 92 sources revealed that 39 presented clinical trial results, 13 described clinical cases, and 40 contained clinical reviews, meeting resolutions, or expert consensus statements on the use of CMMR.

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