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Study comparing pharmaceutical-grade chondroitin sulfate to celecoxib for knee osteoarthritis shows similar rates of pain relief.
Researchers writing in the Annals of the Rheumatic Diseases are recommending that pharmaceutical-grade chondroitin sulfate at 800 mg per day be considered as a first-line treatment for symptomatic knee osteoarthritis.
The recommendation is based on the outcomes of a six-month trial of 604 patients who were randomized to receive chondroitin sulfate or celecoxib (Celebrex). The outcomes for both groups were similar.
“This compelling benefit-risk profile, in light of the known clinical risks associated with chronic usage of NSAIDs and paracetamol, underscores the potential importance of pharmaceutical-grade CS in the management of knee osteoarthritis, especially in this older population requiring long-term treatment,” wrote Jean-Yves Reginster, M.D., Ph.D., of LiÃ¨ge State University in Belgium, and colleagues in the May 22 online issue of the journal.
Chondroitin sulfate is a sulfated glycosaminoglycan composed of chains of alternating D-glucuronic acid and N-acetyl-D-galactosamine. It is recommended for treating knee osteoarthritis and is perceived to offer a possible safer alternative to paracetamol (acetaminophen) and non-steroidal anti-inflammatory drugs (NSAIDs). Some recent studies have questioned the positive benefit-risk profile of analgesics and NSAIDs. A lack of efficacy and a considerable degree of toxicity is associated with acetaminophen, especially in the high range of recommended dosages.
This was a prospective, randomized, six-month, three-arm, double-blind, double-dummy, placebo-controlled trial assessing changes in pain based on a Visual Analogue Scale (VAS) and in the Lequesne Index (LI) as co-primary endpoints.
It included 604 knee osteoarthritis patients (over age 50 years) who were randomized into one of three treatment groups: The chondroitin sulfate treatment group (199 patients) that received one tablet of chondroitin sulfate 800 mg and one capsule of placebo celecoxib per day; the celecoxib group (199 patients) that received one tablet of placebo chondroitin sulfate and one capsule of celecoxib 200 mg (Celebrex/Pfizer); and, the placebo group (205 patients) that received one tablet of placebo chondroitin sulfate and one capsule of placebo celecoxib.
Patients who received chondroitin sulfate and celecoxib showed a statistically greater reduction in pain as compared to the placebo group with no difference seen between the chondroitin sulfate and celecoxib groups. Pain reduction as shown in VAS at 182 days in the chondroitin sulfate group (−42.6 mm) and in the celecoxib group (−39.5 mm) was significantly greater than the placebo group (−33.3 mm) (p=0.001 for CS and p=0.009 for celecoxib). Both secondary endpoints (Minimal-Clinically Important Improvement (MCII) and Patient-Acceptable Symptoms State (PASS) at 182 days improved significantly in the chondroitin sulfate and celecoxib groups.
At day 91 and 182, both chondroitin sulfate and celecoxib induced a significantly greater reduction in LI than placebo (p=0.050 for chondroitin sulfate and p=0.027 for celecoxib at day 91, p=0.023 for chondroitin sulfate and p=0.015 for celecoxib at day 182). No difference was observed between chondroitin sulfate and celecoxib (p=0.799 at day 91 and p=0.890 at day 182, table 2).
Reginster J, Dudler J, Blicharski T, et al. “Pharmaceutical-grade Chondroitin sulfate is as effective as celecoxib and superior to placebo in symptomatic knee osteoarthritis: The ChONdroitin versus CElecoxib versus Placebo Trial (CONCEPT).” Annals of the Rheumatic Diseases. Published Online First: 22 May 2017. DOI: 10.1136/annrheumdis-2016-210860.