Abstract
This study aimed to investigate the effectiveness and safety of glucosamine, chondroitin, the two in combination, or celecoxib in the treatment of knee osteoarthritis (OA). PubMed, Embase and Cochrane Library were searched through from inception to February 2015. A total of 54 studies covering 16427 patients were included. Glucosamine plus chondroitin, glucosamine alone, and celecoxib were all more effective than placebo in pain relief and function improvement. Specifically, celecoxib is most likely to be the best treatment option, followed by the combination group. All treatment options showed clinically significant improvement from baseline pain, but only glucosamine plus chondroitin showed clinically significant improvement from baseline function. In terms of the structure-modifying effect, both glucosamine alone and chondroitin alone achieved a statistically significant reduction in joint space narrowing. Although no significant difference was observed among the five options with respect to the three major adverse effects (withdrawal due to adverse events, serious adverse events and the number of patients with adverse events), the additional classical meta-analysis showed that celecoxib exhibited a higher rate of gastrointestinal adverse effect comparing with the placebo group. The present study provided evidence for the symptomatic efficacy of glucosamine plus chondroitin in the treatment of knee OA.
Highlights
In recent years, there has been a fierce controversy over the efficacy of glucosamine, chondroitin, or the two in combination in the treatment of knee osteoarthritis (OA)[1]
A network meta-analysis published in 2010 concluded that glucosamine, chondroitin, and the two in combination did not relieve joint pain or exerted an impact on narrowing of joint space when compared with placebo, and health authorities and health insurers should not cover the costs of these preparations[12]
This network meta-analysis is subject to the following inclusion criteria: (1) randomized controlled trial (RCT); (2) studies about knee OA patients; (3) studies containing at least two of the following treatments: 200 mg/day oral celecoxib, glucosamine, chondroitin, combination of glucosamine and chondroitin, and placebo; (4) studies reporting the pain, function, structure-modifying effect or the side effect outcomes of patients; (5) English literature; (6) availability of data
Summary
There has been a fierce controversy over the efficacy of glucosamine, chondroitin, or the two in combination in the treatment of knee osteoarthritis (OA)[1]. If glucosamine and chondroitin are useless, a great deal of money is being wasted In another respect, American Food and Drug Administration (FDA) had approved celecoxib as the first specific inhibitor of cyclo-osygenase-2 (COX-2) in December of 1998. The evidence was limited because only ten trials were included in their study and only one direct comparison (the combination group versus placebo) was available at that time Celecoxib, another widespread used oral agent in the treatment of OA, was not included in their Bayesian Network Model[12]. On the basis of existing evidences, this study conducted a network meta-analysis of RCTs to examine the safety and efficacy of glucosamine, chondroitin, the combination of the two, or celecoxib in the control of knee OA
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