Subgroup analyses of the effectiveness of oral glucosamine for knee and hip osteoarthritis: a systematic review and individual patient data meta-analysis from the OA trial bank

Abstract

Although proposed and debated for several years, open trial data are not widely made available for studies of glucosamine for OA, especially those sponsored by industry. Currently, there is no good evidence to support the use of glucosamine for hip or knee OA and an absence of evidence to support specific consideration of glucosamine for any clinically relevant OA subgroup according to baseline pain severity, BMI, sex, structural abnormalities or presence of inflammation.

Different glucosamine sulfate products generate different outcomes on osteoarthritis symptoms

“…Indeed, the recent recommendations by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases strongly support that only prescription crystalline glucosamine sulfate should be used as background pharmacological treatment in the first step of the knee OA management algorithm,17 since other glucosamine-containing products are not effective as confirmed by this meta-analysis 1…”

“…Runhaar and colleagues1 produced an elegant meta-analysis of various glucosamine-containing products in knee and hip osteoarthritis (OA), based on individual patient data (IPD). Although they were able to access and analyse only 5 out 21 eligible studies, their results are in agreement with most glucosamine meta-analyses in OA: glucosamine products other than prescription crystalline glucosamine sulfate are not effective in hip or knee OA pain and function.…”

“…The leading group of the present OA Trial Bank initiative1 is well aware of this, as acknowledged in their article and based on a previous study of theirs in which crystalline glucosamine sulfate even showed compelling hints of efficacy in an OA prevention trial setting 7. Nevertheless, they were denied access to the three large and high-quality (ie, low risk of bias) pivotal trial data of prescription crystalline glucosamine sulfate8–10 by the sponsor (Rottapharm).…”

Response to: ‘Different glucosamine sulfate products generate different outcomes on osteoarthritis symptoms’ by Reginster et al

“…We appreciate the interest that Reginster and colleagues1 showed in our publication on subgroup effects of oral glucosamine for osteoarthritis (OA) 2. We are pleased that the eLetter authors do not put forward any critique of our publication that requires our justification or clarification.…”

“…Since available randomised controlled trials are usually not powered to show subgroup effects, these effects might have been overlooked before. We therefore undertook this individual patient data meta-analysis,2 where more than 50% of all available participants (1625 individuals) from the placebo-controlled trials were retrieved to evaluate the effectiveness of oral glucosamine for several predefined clinical relevant subgroups, using methodologically robust methods. We would highlight that, contrary to what Reginster et al suggest, the presented results (ie, oral glucosamine was not superior to placebo in any of the predefined subgroups) do add to the available knowledge regarding the effectiveness of oral glucosamine for OA, as analyses within clinical relevant subgroups using individual patient data have not been published before.…”