Chondroitin sulfate outperformed celecoxib in reducing the progression of cartilage volume loss in patients with osteoarthritis of the knee, according to results presented at the 2015 annual meeting of the American College of Rheumatology (ACR).1 The trial was the first to demonstrate the superior efficacy of chondroitin sulfate over celecoxib in reducing the long-term progression of structural changes in knee osteoarthritis. Both agents were equally effective at reducing symptoms. “We felt the present study was necessary in order to establish—using the most recent imaging technology available, quantitative magnetic resonance imaging (qMRI)—whether chondroitin sulfate can truly and effectively reduce the progression of the disease in patients suffering from knee OA,” commented lead investigator Jean-Pierre Pelletier, MD.
The study involved 194 people with symptomatic knee osteoarthritis and synovitis. The patients were randomly assigned to 2 groups: one group received chondroitin 1200 mg once daily while the other received celecoxib 200 mg once daily. Patients were treated for 24 months. At baseline, 12 months, and 24 months, patients were evaluated with qMRI in order to measure cartilage volume loss, bone marrow lesion size, and thickness of the synovial membrane. The presence of joint swelling and effusion was clinically evaluated. Clinical symptoms were also assessed by validated questionnaires. In the intent-to-treat population, patients receiving chondroitin (n=97) demonstrated a decrease in cartilage volume loss at 12 months (P=.017), at 24 months in the medial tibiofemoral compartment (P=.013), and global knee at 12 months (P=.034) and 24 months (P=.054) compared with celecoxib (n=97). No between-group differences were noted over time in the change in synovial thickness or bone marrow lesions. Chondroitin and celecoxib were similarly effective in reducing osteoarthritis symptoms over the course of the study.
Chondroitin in Guidelines
Chondroitin sulfate, a natural compound, is considered to be an SYSADOA (Symptomatic Slow-Acting Drug for Osteoarthritis). Its use has generated controversy among clinicians, due in part to its status in the United States as an over-the-counter nutritional supplement. While acknowledging that some clinicians may disagree with its position, the ACR conditionally recommended against the use of chondroitin sulfate for patients with osteoarthritis of the knee in their 2012 guidelines. Reasons for the ACR’s decision included the lack of US Food and Drug Administration-approved prescription-quality chondroitin formulations, several meta-analyses of studies on chondroitin showing a high degree of heterogeneity in effect size, and results from a 2010 network analysis that failed to demonstrate a clinically relevant effect of chondroitin, glucosamine, or their combination on perceived joint pain.2 In Europe, chondroitin sulfate is a registered prescription drug. The European League Against Rheumatism (EULAR), the 2010 Osteoarthritis Research Society International (OARSI) guidelines for the treatment of symptomatic knee osteoarthritis, and the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) all recommend its use based on expert opinion and reviews of the medical literature.3,4 In an email interview, Dr Pelletier told Rheumatology Advisor that SYSADOAs are of interest because of their good safety profile, efficacy on symptoms, and protective effect on disease progression. “However,” he pointed out, “patients should be made aware that studies exploring the efficacy of chondroitin sulfate for knee osteoarthritis treatment were conducted using highly purified, pharmaceutical-grade chondroitin sulfate.”
- Pelletier JP, Raynauld JP, Beaulieu A, et al. In a two-year double-blind randomized controlled multicenter study, chondroitin sulfate was significantly superior to celecoxib at reducing cartilage loss with similar efficacy at reducing disease symptoms in knee osteoarthritis patients [abstract]. Arthritis Rheumatol. 2015;67 (suppl 10). http://acrabstracts.org/abstract/in-a-two-year-double-blind-randomized-controlled-multicenter-study-chondroitin-sulfate-was-significantly-superior-to-celecoxib-at-reducing-cartilage-loss-with-similar-efficacy-at-reducing-disease-sym/.
- Hochberg MC, Altman RD, April KT, et al; American College of Rheumatology. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 2012;64(4):465-474.
- Henrotin Y, Marty M, Mobasheri A. What is the current status of chondroitin sulfate and glucosamine for the treatment of knee osteoarthritis? Maturitas. 2014;78(3):184-187. doi: 10.1016/j.maturitas.2014.04.015. Epub 2014 May 1.
- Bruyère O, Cooper C, Pelletier JP, et al. An algorithm recommendation for the management of knee osteoarthritis in Europe and internationally: a report from a task force of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Semin Arthritis Rheum. 2014;44(3):253-263.