glucosamine chondroitin
Place in Therapy
The place of glucosamine and chondroitin in the treatment of OA remains uncertain. Although there is a wealth of literature available many of the available studies are poorly designed with numerous flaws1. Of the better designed trials, results have been conflicting. A large, well-designed trial, the GAIT trial, found that improvement in OA-related knee pain with the use of a glucosamine hydrochloride/chondroitin sulfate combination was not statistically significant2. The study of glucosamine sulfate, particularly the Rottapharm brand, has demonstrated some relief of symptoms in knee OA3,4, however, the Rottapharm brand is not available in North America and the standardization of available products may be uncertain3. Further, many of the studies which incorporated the Rotta brand had some relationship with this manufacturer, so an element of bias in the results cannot be ruled out. Finally, any positive results that glucosamine/chondroitin may have towards knee OA does not imply the same level of relief to other types of OA, and this must be taken into consideration as well.
Until more high quality studies are available which clearly discern the effect of glucosamine/chondroitin in OA, it remains a reasonable option for use as an adjunctive agent with first-line options such as acetaminophen or NSAIDs, since both well-tolerated. Glucosamine sulfate 1500 mg/day should be recommended over glucosamine hydrochloride, in conjunction with chondroitin 1200 mg/day. Glucosamine and chondroitin should not be used as a substitute for acetaminophen or NSAIDs.
References:
1. Buys LM, Elliott M. Chapter 101. Osteoarthritis. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey L. eds. Pharmacotherapy: A Pathophysiologic Approach, 8e. New York: McGraw-Hill; 2011. http://accesspharmacy.mhmedical.com.proxy.lib.uwaterloo.ca/content.aspx?bookid=462&Sectionid=41100881. Accessed March 03, 2014.
2. Clegg DO, Reda DJ, Harris CL, Klein MA, O'Dell JR, Hooper MM, et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. N Engl J Med. 2006 Feb 23; 354(8):795–808.
3. Towheed T, Maxwell L, Anastassiades TP, et al. Glucosamine therapy for treating osteoarthritis. Cochrane Database Syst Rev 2005;(2):CD002946.
4. Herrero-Beaumont G, Ivorra JAR, Trabado M, Blanco FJ, Benito P, Martin-Mola E, et al.Glucosamine sulfate in the treatment of knee osteoarthritis symptoms. Arthritis and Rheumatism 2007;56(2):555–67.
Until more high quality studies are available which clearly discern the effect of glucosamine/chondroitin in OA, it remains a reasonable option for use as an adjunctive agent with first-line options such as acetaminophen or NSAIDs, since both well-tolerated. Glucosamine sulfate 1500 mg/day should be recommended over glucosamine hydrochloride, in conjunction with chondroitin 1200 mg/day. Glucosamine and chondroitin should not be used as a substitute for acetaminophen or NSAIDs.
References:
1. Buys LM, Elliott M. Chapter 101. Osteoarthritis. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey L. eds. Pharmacotherapy: A Pathophysiologic Approach, 8e. New York: McGraw-Hill; 2011. http://accesspharmacy.mhmedical.com.proxy.lib.uwaterloo.ca/content.aspx?bookid=462&Sectionid=41100881. Accessed March 03, 2014.
2. Clegg DO, Reda DJ, Harris CL, Klein MA, O'Dell JR, Hooper MM, et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. N Engl J Med. 2006 Feb 23; 354(8):795–808.
3. Towheed T, Maxwell L, Anastassiades TP, et al. Glucosamine therapy for treating osteoarthritis. Cochrane Database Syst Rev 2005;(2):CD002946.
4. Herrero-Beaumont G, Ivorra JAR, Trabado M, Blanco FJ, Benito P, Martin-Mola E, et al.Glucosamine sulfate in the treatment of knee osteoarthritis symptoms. Arthritis and Rheumatism 2007;56(2):555–67.