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Title: Glucosamine Has Structural/Symptomatic Efficacy while Chondroitin Has Symptomatic Efficacy in Knee Osteoarthritis

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Archives of Internal Medicine 2003;163:1514-1522.
07/17/2003 11:22:42 AM
By Elda Hauschildt

Glucosamine has structural efficacy and both glucosamine and chondroitin have indistinguishable symptomatic efficacies in knee osteoarthritis, according to comprehensive meta-analyses by European researchers. Investigators from Belgium and France conducted seven individual, outcome-oriented meta-analyses using 15 randomised clinical trials selected from among approximately 500 studies on the basis of high methodological quality. "Our work provides a clear, evidence-based advance regarding the interest in the wide use of glucosamine and chondroitin as disease-modifying compounds in the treatment of knee osteoarthritis through an accurate, conservative analysis of the most reliable experiments performed until now," write researchers led by Dr. Jean-Yves Reginster, from University of Liege, in Liege, Belgium. The data covered 1,020 patients who took glucosamine and 755 who took chondroitin. The researchers report that quality scores ranged from 60% to 100%, with a mean of 78.4%. Mean quality in the glucosamine trials was 90%, which was significantly higher than the 68.4% in the chondroitin trials. "Our data demonstrate efficacy for glucosamine on joint space narrowing and the Western Ontario McMaster University Osteoarthritis Index (WOMAC) and comparable efficacies of chondroitin and glucosamine on the Lequesne Index (LI), visual analogue scale (VAS) for pain and VAS for mobility assessment, in light of the most reliable scientific evidence," they explain. Inclusion criteria for the meta-analyses meant study outcomes had to meet those used by both the United States Food and Drug Administration and the European Agency for Evaluation of Medicinal Products for registering drugs used in treating osteoarthritis. All 15 trials were of randomised, double-blind, placebo- controlled, parallel-group prospective design and assessed the structural and/or symptomatic efficacy of oral glucosamine or chondroitin on knee or hip osteoarthritis. The studies were published or performed between January 1980 and March 2002. Trials were excluded of either compound was administered intra-articularly or intravenously. Individual demographic baselines were well matched in each study. There were no statistical differences for participants on age, sex, body mass index and radiologic score at inclusion. There were also no statistical differences between patients enrolled in glucosamine or chondroitin studies regarding mean age (62.1 years), radiologic score (1.96) or body mass index (27.6). Further studies should investigate the relationship among time, dose, patient baseline characteristics and structural efficacy, the investigators write, in order to develop accurate, disease-modifying characteristics of the two compounds. They note that both compounds were well tolerated by patients.

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