Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysisBMJ 2010; 341 doi: http://dx.doi.org/10.1136/bmj.c4675 (Published 16 September 2010) Cite this as: BMJ 2010;341:c4675
- Simon Wandel, research fellow12,
- Peter Jüni, professor and head of division12,
- Britta Tendal, research fellow3,
- Eveline Nüesch, research fellow12,
- Peter M Villiger, director4,
- Nicky J Welton, senior research fellow5,
- Stephan Reichenbach, senior research fellow14,
- Sven Trelle, senior research fellow12
- 1Institute of Social and Preventive Medicine, University of Bern, Switzerland
- 2CTU Bern, Bern University Hospital, Switzerland
- 3Nordic Cochrane Centre, Righospitalet, Copenhagen, Denmark
- 4Department of Rheumatology, Clinical Immunology, and Allergology, Bern University Hospital, Switzerland
- 5Academic Unit of Primary Health Care, Department of Community Based Medicine, University of Bristol, Bristol, United Kingdom
- Correspondence to: P Jüni, Institute of Social and Preventive Medicine, University of Bern, Switzerland
- Accepted 5 July 2010
Objective To determine the effect of glucosamine, chondroitin, or the two in combination on joint pain and on radiological progression of disease in osteoarthritis of the hip or knee.
Design Network meta-analysis. Direct comparisons within trials were combined with indirect evidence from other trials by using a Bayesian model that allowed the synthesis of multiple time points.
Main outcome measure Pain intensity. Secondary outcome was change in minimal width of joint space. The minimal clinically important difference between preparations and placebo was prespecified at −0.9 cm on a 10 cm visual analogue scale.
Data sources Electronic databases and conference proceedings from inception to June 2009, expert contact, relevant websites.
Eligibility criteria for selecting studies Large scale randomised controlled trials in more than 200 patients with osteoarthritis of the knee or hip that compared glucosamine, chondroitin, or their combination with placebo or head to head.
Results 10 trials in 3803 patients were included. On a 10 cm visual analogue scale the overall difference in pain intensity compared with placebo was −0.4 cm (95% credible interval −0.7 to −0.1 cm) for glucosamine, −0.3 cm (−0.7 to 0.0 cm) for chondroitin, and −0.5 cm (−0.9 to 0.0 cm) for the combination. For none of the estimates did the 95% credible intervals cross the boundary of the minimal clinically important difference. Industry independent trials showed smaller effects than commercially funded trials (P=0.02 for interaction). The differences in changes in minimal width of joint space were all minute, with 95% credible intervals overlapping zero.
Conclusions Compared with placebo, glucosamine, chondroitin, and their combination do not reduce joint pain or have an impact on narrowing of joint space. Health authorities and health insurers should not cover the costs of these preparations, and new prescriptions to patients who have not received treatment should be discouraged.
We thank Bruno da Costa for helpful discussions related to minimal clinically important differences and limitations of effect sizes and Malcolm Sturdy for database development and maintenance.
Contributors: SW and PJ contributed equally. PJ conceived the study. PJ, ST, and SW and were responsible for conception and design of the study. SW, PJ, NJW, and ST did the analysis and interpreted the analysis in collaboration with BT, EN, PMV, and SR. SW, PJ, BT, EN, SR, and ST were responsible for the acquisition of data. PJ and SW wrote the ﬁrst draft of the manuscript. All authors critically revised the manuscript for important intellectual content and approved the ﬁnal version of the manuscript. PJ and SR obtained public funding. PJ and PMV provided administrative, technical, and logistical support. PJ is guarantor.
Funding: The study was funded by grants from the Swiss National Science Foundation’s National Research Program 53 on musculoskeletal health (PJ and SR) (No 4053-0-104762/3). PJ was a senior research fellow in the Program for Social Medicine, Preventive and Epidemiological Research funded by the Swiss National Science Foundation (grant No 3233-066377). SR was a recipient of a research fellowship funded by the Swiss National Science Foundation (grant No PBBEB-115067). SW was a recipient of an individual fellowship of the Janggen-Poehn-Foundation. The study sponsor had no role in study design, data collection, data synthesis, data interpretation, writing the report, or the decision to submit the manuscript for publication. None of the authors is affiliated with or funded by any manufacturer of any of the agents evaluated in this study.
Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any institution for the submitted work; no financial relationships with any institutions that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.
Ethical approval: Not required.
Data sharing: Technical details, statistical code, and dataset available from the corresponding author.
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