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Glucosamine and Chondroitin Sulfate for Knee Osteoarthritis
Glucosamine plus chondroitin sulfate were ineffective overall, but conferred some benefit in a subgroup of patients with moderate-to-severe symptoms.
In this long-awaited multicenter NIH-supported trial, researchers examined the dietary supplements glucosamine and chondroitin sulfate in patients with knee osteoarthritis. The trial included 1583 patients with knee pain for at least 6 months, plus radiographic evidence of knee osteoarthritis. Patients were randomized to receive placebo, glucosamine hydrochloride (500 mg 3 times daily), chondroitin sulfate (400 mg 3 times daily), both supplements, or celecoxib (200 mg daily). A response to treatment was defined as a 20% decrease in pain on a standardized scale at 24 weeks.
Overall response rates were 60%, 64%, 65%, 67%, and 70% in the placebo, glucosamine, chondroitin, glucosamine/chondroitin, and celecoxib groups, respectively. Only the response to celecoxib was statistically significant compared with placebo. In a subgroup of patients with moderate-to-severe pain (22% of participants), response rates were 54%, 66%, 61%, 79%, and 69%, respectively. Only the 79% response to combined glucosamine/chondroitin was statistically significant compared with placebo. Patients' global assessments of response to therapy were not statistically significant for any active treatment (compared with placebo) in either the mild or moderate-to-severe subgroups.
Comment: In this trial, glucosamine hydrochloride, chondroitin sulfate, or combination therapy conferred no benefit in patients with mild knee osteoarthritis. The observed benefit from combined therapy in the subgroup with moderate-to-severe symptoms is provocative and deserves further study. An editorialist outlines several caveats about this study and questions whether outcomes for glucosamine hydrochloride (used in this study) can be extrapolated to glucosamine sulfate (used in many marketed products). Another report on the effect of these supplements on radiographic progression is expected.
— Allan S. Brett, MD
Published in Journal Watch General Medicine February 28, 2006
Citation(s):
Clegg DO et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. N Engl J Med 2006 Feb 23; 354:795-808.
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Hochberg MC. Nutritional supplements for knee osteoarthritis — Still no resolution. N Engl J Med 2006 Feb 23; 354:858-60.
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- Medline abstract (Free)