Study: Can chondroit and glucosamine compete with COX-2 inhibitors in osteoarthritis?

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Reference Hochberg MC, Martel Pelletier J, Monfort J, et al. Combined chondroitine sulfate and glucosamine in painful knee arthrosis: a multicenter, randomized, double -blind study on non -difference towards Celecoxib. Ann Rheum Dis. January 14, 2015. [Epub Ahead of Print] Designed, double-blind non-subdue study participants As part of the multicenter osteoarthritis Intervention Intervention Trial With Symptomatic Slow-Acting Drugs for Osteoarthritis (Moves) 606 patients with X-ray evidence of knee throats and moderate to severe pain from 42 clinics in France, Germany, Germany, Germany, Germany, Germany, Germany, Germany, Poland and Spain selected. The average age of the participants was 63 years; 84 % were women and 99 % white. Intervention Moves patients received either 400 mg chondroitin sulfate ...
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Reference

Hochberg MC, Martel pelletier J, Monfort J, et al. Combined chondroitine sulfate and glucosamine in painful knee arthrosis: a multicenter, randomized, double -blind study on non -difference towards Celecoxib. Ann Rheum Dis. January 14, 2015. [Epub Ahead of Print]

Design

randomized, double -blind non -subdue study

participant

As part of the multicenter osteoarthritis intervention trial with symptomatic slow-acting drugs for osteoarthritis (moves), 606 patients with X-ray evidence of knee Arthritis and moderate to severe pain from 42 clinics in France, Germany, Poland and Spain were selected. The average age of the participants was 63 years; 84 % were women and 99 % white.

Intervention

MOVES patients received either 400 mg chondroitin sulfate (CS) plus 500 mg glucosamin hydrochloride (GH) three times a day or 200 mg COX-2-selective Hemmer Celecoxib (Celebrex) once a day for 6 months. Acetamineophs, up to 3 g a day, was allowed as required.

Primary result measurements

The primary endpoint was the change in the pain scores of the western ontario and McMaster osteoarthritis index (Womac) after 6 months. Secondary measures included stiffness, swelling of the joints and the use of paracetamol. All measures were evaluated after 1, 2, 4 and 6 months.

important knowledge

After 1, 2 and 4 months, Celecoxib was more effective in reducing the Womac pain value than CS+GH. Accordingly, acetaminophen consumption in the CS+GH group was higher after 1 month. After 6 months, however, the average change in the Womac pain value compared to the initial value was ‒186.8 (a decrease by 50.2 %) in the Celecoxib group and ‒185.7 (a decrease by 50.1 %) in the CS+GH group. These results showed the non -subdue of CS+GH compared to Celecoxib after 6 months.

practice implications

The results of this study were surprisingly impressive: a combination of CS+GH was just as effective in pain relief as the popular COX-2-inhibitor Celecoxib.

The current study used a combination protocol, but there is no way to know whether the positive results are due to chondroitin, glucosamine or their synergistic effect.

A superficial review of new studies on chondroitin and glucosamine would not predict such a robust finding. 1.2 The conclusions of published meta -analyzes to chondroitin, glucosamine or their combination are contradictory. Even the study, which was used as a model for the current study, was not conclusive: the glucosamine/chondroitin arthritis intervention intervention trial (gait) was a large randomized controlled study (RCT) that showed no benefits of CS+GH over the entire Gait population and only "possible benefits" in the sub-group of patients with moderate to strong Pain. 3
Most studies have evaluated a combination of chondroitin plus glucosamine, which makes it difficult to distinguish their individual effects. Recently carried out studies with glucosamine alone could not demonstrate its effectiveness; These studies include one that was published in 2010 magazine of the American Medical Association and another that was published in 2014 in arthritis & rheumatology . 4.5 In contrast Osteoarthritis (oa) placebo is superior. 6 The current study used a combination protocol, but there is no way to know whether the positive results are due to chondroitine, glucosamine or their synergistic effect.
Another confusing factor in the design of the current study was the form of the glucosamine used - GH. A meta-analysis from 2013 came to the conclusion that glucosaminsulfate (GS), but not gh, can relieve pain and improve the function in patients with knee-oa. 7 The osteoarthritis research society also came to the conclusion that GS delivers more consistent results than GH. Explanation for the choice of glucosamine, which questions whether one of the clinical effects can be attributed to glucosamine or chondroitin should be attributed alone.
Finally,
The primary result of the result in the current study was the symptomatic improvement, a measure that may not completely reflect the advantages of chondroitin and glucosamine. Since these compounds represent a source of glycosaminoglycans for the production of collagen and synovial fluid, you could have tissue -modifying effects at OA. Two recently carried out RCTs have shown that a combination of GS+CS significantly reduces the loss of cartilage and the narrowing of the joint column in the event of two years of taking. 9.10 In one of these studies, the X -ray detection did not correlate with symptomatic improvement, 9 and in the other study the result was more Quantitative magnetic resonance imaging as measured by the standard X-ray. 10 Interestingly, there were in patients who revenge glucosamine for 12 weeks, a reduction in immune reactivity in collagen type I and a reduction in receptors for end products of the advanced glycation compared to patients or non-substantial anti-inflammatory medication or Placebo revenue. 11 Together These studies indicate that chondroitine and glucosamine may have tissue -modifying effects that are only recognized if the result measurements aim to do so.
Standard pharmaceutical treatments for OA aim at relieving the symptoms. 12 chondroitin and glucosamine are unique in their potential to offer tissue -modifying effects. The results of the current study indicate that these natural active ingredients can cause symptomatic relief even in patients with moderate to severe knee arthritis.
The current study used a combination protocol, an inferior glucosamine preparation and results measurements based only on the symptomatic improvement. Despite these weaknesses, the results showed the non-subdue of CS+GH compared to a COX-2 inhibitor. These results are impressive and should not be ignored. Chondroitin and glucosamine are natural active ingredients with good safety profiles, while COX-2 inhibitors hide both gastrointestinal and cardiovascular risks.

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