Clinical Question

Is combined chondroitin/glucosamine as effective as celecoxib (Celebrex) in reducing pain and improving function in patients with painful knee osteoarthritis?

Bottom Line

For patients with painful knee osteoarthritis, a high-dose combination of glucosamine hydrochloride (1,500 mg) and chondroitin (1,200 mg) was as effective in lessening pain and stiffness and improving function as celecoxib (200 mg). Other studies have not found benefit. It is time for someone to analyze all the studies of chondroitin/glucosamine to determine who is most likely to benefit. (Level of Evidence = 1b)

Synopsis

The 606 patients in this study were enrolled by one of 42 rheumatologists practicing in France, Germany, Poland, or Spain. The patients were an average age of 63 years, most were women (84%), and almost all were white (99%). They all had radiographic evidence of knee osteoarthritis and had severe pain as measured by a score greater than 300 (of a possible 500) on the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index, which is the standard research scale used to evaluate pain, stiffness, and function. The patients were randomized (concealed allocation unknown) to receive 400-mg chondroitin sulfate/500-mg glucosamine hydrochloride three times a day or 200-mg celecoxib every day for six months (both with matched placebo). The glucosamine/chondroitin dose is a little higher than is typically recommended and studied. At six months, using a modified intention-to-treat analysis that included only 94% of enrolled patients, WOMAC pain scores were decreased by 50% in both groups, stiffness scores decreased 46.9% with the combination vs. 49.2% with celecoxib (P = not significant), and function improved similarly (decreased in 45.5% vs. 46.4%; P = not significant).

Study design: Randomized controlled trial (double-blinded)

Funding source: Industry

Allocation: Uncertain

Setting: Outpatient (specialty)

Reference: HochbergMCMartel-PelletierJMonfortJet alMOVES Investigation GroupCombined chondroitin sulfate and glucosamine for painful knee osteoarthritis: a multicentre, randomised, double-blind, non-inferiority trial versus celecoxib. Ann Rheum Dis2016;75(1):37–44.