Post by KenNiemann on Apr 17, 2006 2:28:46 GMT -5
Glucosamine-Chondroitin Sulfate Can Ease Severe Pain
By Peggy Peck , MedPage Today Staff Writer
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.
MedPage Today Action Points
* Explain to patients who ask that in contrast to those with mild pain those who have severe-to-moderate knee pain from osteoarthritis may get some relief from a three-month trial of glucosamine plus chondroitin sulfate, but this finding should be confirmed by another study.
Review
SALT LAKE CITY, Feb. 22, 2006 - Daily doses of glucosamine and chondroitin sulfate, either alone or in combination, did not significantly reduce mild knee pain from osteoarthritis, compared with placebo, according to researchers here.
But in a subset of patients with moderate-to-severe knee pain, the combination of glucosamine and chondroitin sulfate significantly reduced pain and improved function, as measured by the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, investigators reported in the Feb. 23, 2006 issue of the New England Journal of Medicine.
Results of the 1,583-patient Glucosamine-chondroitin Arthritis Intervention Trial (GAIT) suggested that treatment with Celebrex (celecoxib) was associated with a "much faster time to response" than treatment with the popular alternative supplements either alone or in combination, found Daniel O. Clegg, M.D., of the University of Utah School of Medicine and colleagues.
GAIT, which was supported by grants from the National Center for Complementary and Alternative Medicine and the National Institute of Arthritis and Musculoskeletal and Skin Diseases, recruited 1,583 patients with symptomatic knee osteoarthritis.
Patients were randomized to 1,500 mg of glucosamine hydrocholoride, 1,200 mg of chondroitin sulfate, both glucosamine and chondroitin, 200 mg of Celebrex, or placebo for 24 weeks. Patients were also permitted up
to 4,000 mg of Tylenol (acetaminophen) daily for rescue analgesia.
Stratified by pain, 354 patients had moderate-to-severe pain and 1,229 had mild pain. The primary outcome measure was a 20% decrease in knee
pain from baseline to week 24.
Deryk Jones, M.D., section head for sports medicine and cartilage restoration at the Ochsner Clinic in New Orleans, said the study provides valuable information for him and other orthopedists who are routinely recommending glucosamine-chondroitin.
"When you look at the results for the patients with moderate-to-severe pain, all pain parameters went down and those decreases were statistically significant with P values of 0.008 and 0.009," Dr. Jones said.
Those findings suggest that using thesupplements "isn't going to make a difference for patients with mild pain, but those with severe symptoms the treatment could be helpful," he said. Yet he added that study results suggested that glucosamine-chondroitin treatment does not change stiffness. "These supplements have been touted for an ability to regenerate cartilage, but there is no evidence of that."
Among the findings of the study:
· 223 of 318 patients randomized to Celebrex had a 20% decrease in WOMAC pain score (P=0.008).
· 211 of 317 patients randomized to glucosamine plus chondroitin sulfate had 20% reduction in WOMAC pain score (P=0.09).
· 203 of 317 patients in the glucosamine group reduced WOMAC pain score by 20% (P=0.30) and 208 of 318 patients in the chondroitin sulfate arm posted 20% reductions in pain scores (P=0.17).
· 60% of patients in the placebo arm (188 of 313) reduced pain by 20% from baseline.
By contrast, when the findings were analyzed by pain severity, 79.2 of patients treated with glucosamine plus chondroitin sulfate lowered pain scores by 20% (P=0.002) versus 69.4% of moderate-to-severe pain patients randomized to Celebrex (P=0.06).
Similarly, the moderate-to-severe pain patients in the combination treatment arm had significant improvements in WOMAC function score
(P=0.008) versus moderate-to-severe pain patients randomized to Celebrex (P=0.10).
In an editorial that accompanied the GAIT results, Marc C. Hochberg, M.D., M.P.H., of the University of Maryland in Baltimore suggested cautious interpretation of the results from the moderate-to-severe pain
group carefully because "[Celebrex], the active control, had no significant effect in this subgroup."
Moreover, Dr. Hochberg pointed out that the study is limited by high attrition rates (20%) in the placebo arm as well as in each of the supplement arms combined with an unexpectedly high response in the
placebo group.
Dr. Hochberg also wrote that the study authors might have observed a better response if they had used the Rottapharm brand of glucosamine sulfate, which has demonstrated efficacy in seven randomized trials,
rather than glucosamine hydrocholoride.
He concluded that patients who want to take supplements should be advised to take glucosamine sulfate and "for those with severe pain, that taking chondroitin sulfate with glucosamine sulfate may have an additive effect." Finally, he said that if no benefit is evident after three months of treatment, the supplements should be stopped.
Primary source: New England Journal of Medicine
Source reference: Clegg DO "Glucosamine, Chondroitin Sulfate, and the Two in Combination for Painful Knee Osteoarthritis" N Engl J Med 2006;354:795-808
Additional source: New England Journal of Medicine
Source reference: Hochberg MC "Nutritional Supplements for Knee Osteoarthritis-Still No Resolution" N Engl J Med 2006; 354:858-860
By Peggy Peck , MedPage Today Staff Writer
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.
MedPage Today Action Points
* Explain to patients who ask that in contrast to those with mild pain those who have severe-to-moderate knee pain from osteoarthritis may get some relief from a three-month trial of glucosamine plus chondroitin sulfate, but this finding should be confirmed by another study.
Review
SALT LAKE CITY, Feb. 22, 2006 - Daily doses of glucosamine and chondroitin sulfate, either alone or in combination, did not significantly reduce mild knee pain from osteoarthritis, compared with placebo, according to researchers here.
But in a subset of patients with moderate-to-severe knee pain, the combination of glucosamine and chondroitin sulfate significantly reduced pain and improved function, as measured by the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, investigators reported in the Feb. 23, 2006 issue of the New England Journal of Medicine.
Results of the 1,583-patient Glucosamine-chondroitin Arthritis Intervention Trial (GAIT) suggested that treatment with Celebrex (celecoxib) was associated with a "much faster time to response" than treatment with the popular alternative supplements either alone or in combination, found Daniel O. Clegg, M.D., of the University of Utah School of Medicine and colleagues.
GAIT, which was supported by grants from the National Center for Complementary and Alternative Medicine and the National Institute of Arthritis and Musculoskeletal and Skin Diseases, recruited 1,583 patients with symptomatic knee osteoarthritis.
Patients were randomized to 1,500 mg of glucosamine hydrocholoride, 1,200 mg of chondroitin sulfate, both glucosamine and chondroitin, 200 mg of Celebrex, or placebo for 24 weeks. Patients were also permitted up
to 4,000 mg of Tylenol (acetaminophen) daily for rescue analgesia.
Stratified by pain, 354 patients had moderate-to-severe pain and 1,229 had mild pain. The primary outcome measure was a 20% decrease in knee
pain from baseline to week 24.
Deryk Jones, M.D., section head for sports medicine and cartilage restoration at the Ochsner Clinic in New Orleans, said the study provides valuable information for him and other orthopedists who are routinely recommending glucosamine-chondroitin.
"When you look at the results for the patients with moderate-to-severe pain, all pain parameters went down and those decreases were statistically significant with P values of 0.008 and 0.009," Dr. Jones said.
Those findings suggest that using thesupplements "isn't going to make a difference for patients with mild pain, but those with severe symptoms the treatment could be helpful," he said. Yet he added that study results suggested that glucosamine-chondroitin treatment does not change stiffness. "These supplements have been touted for an ability to regenerate cartilage, but there is no evidence of that."
Among the findings of the study:
· 223 of 318 patients randomized to Celebrex had a 20% decrease in WOMAC pain score (P=0.008).
· 211 of 317 patients randomized to glucosamine plus chondroitin sulfate had 20% reduction in WOMAC pain score (P=0.09).
· 203 of 317 patients in the glucosamine group reduced WOMAC pain score by 20% (P=0.30) and 208 of 318 patients in the chondroitin sulfate arm posted 20% reductions in pain scores (P=0.17).
· 60% of patients in the placebo arm (188 of 313) reduced pain by 20% from baseline.
By contrast, when the findings were analyzed by pain severity, 79.2 of patients treated with glucosamine plus chondroitin sulfate lowered pain scores by 20% (P=0.002) versus 69.4% of moderate-to-severe pain patients randomized to Celebrex (P=0.06).
Similarly, the moderate-to-severe pain patients in the combination treatment arm had significant improvements in WOMAC function score
(P=0.008) versus moderate-to-severe pain patients randomized to Celebrex (P=0.10).
In an editorial that accompanied the GAIT results, Marc C. Hochberg, M.D., M.P.H., of the University of Maryland in Baltimore suggested cautious interpretation of the results from the moderate-to-severe pain
group carefully because "[Celebrex], the active control, had no significant effect in this subgroup."
Moreover, Dr. Hochberg pointed out that the study is limited by high attrition rates (20%) in the placebo arm as well as in each of the supplement arms combined with an unexpectedly high response in the
placebo group.
Dr. Hochberg also wrote that the study authors might have observed a better response if they had used the Rottapharm brand of glucosamine sulfate, which has demonstrated efficacy in seven randomized trials,
rather than glucosamine hydrocholoride.
He concluded that patients who want to take supplements should be advised to take glucosamine sulfate and "for those with severe pain, that taking chondroitin sulfate with glucosamine sulfate may have an additive effect." Finally, he said that if no benefit is evident after three months of treatment, the supplements should be stopped.
Primary source: New England Journal of Medicine
Source reference: Clegg DO "Glucosamine, Chondroitin Sulfate, and the Two in Combination for Painful Knee Osteoarthritis" N Engl J Med 2006;354:795-808
Additional source: New England Journal of Medicine
Source reference: Hochberg MC "Nutritional Supplements for Knee Osteoarthritis-Still No Resolution" N Engl J Med 2006; 354:858-860