Chondroitin sulfate plus glucosamine is comparable to celecoxib in reducing pain in patients with knee osteoarthritis and is a safe alternative for patients with cardiovascular or gastrointestinal conditions who have contraindications to celecoxib.
The findings were presented here at the 2014 Annual Scientific Meeting of the American College of Rheumatology/Association of Rheumatology Health Professionals (ACR/ARHP) by Marc Hichberg, MD, University of Maryland School of Medicine, Baltimore, Maryland.
The Multicentre Osteoarthritis Intervention Trial With Sysadoa (MOVES) compared the efficacy and safety of a fixed-dose chondroitin sulfate plus glucosamine hydrochloride combination with celecoxib in patients with knee osteoarthritis and moderate-to-severe knee pain among 606 patients from 42 medical centres in France, Germany, Poland, and Spain.
Patients with knee osteoarthritis (Kellgren-Lawrence grade 2 or 3) and moderate-to-severe pain according to the Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain score were randomised to an oral daily dose of chondroitin sulfate 400 mg plus glucosamine hydrochloride 500 mg or to celecoxib 200 mg for 6 months.
Patients with a history of cardiovascular or gastrointestinal disease were excluded.
The primary outcome was a decrease in the WOMAC pain score from baseline to 6 months.
The mean age of the patients at baseline was 62.7 years. Most (83.9%) were women. The mean WOMAC pain score was 371.3 ± 41.6. The majority of patients (62.6%) had Kellgren-Lawrence grade 2 osteoarthritic knee pain. The two groups were comparable at baseline.
Absolute WOMAC pain scale scores for the combination group and the celecoxib group at baseline were 372.0 and 370.6, respectively. The respective scores at 1 month (267.7 and 236.4), 2 months (231.0 and 206.0), and 4 months (209.9 and 183.5) significantly favoured celecoxib (P < .001, P = .008, and P = .007, respectively). However, the WOMAC scores at 6 months were comparable (185.8 and 184.7, respectively; P = .917).
The adjusted mean change (95% confidence interval [CI]) from baseline to 6 months in WOMAC pain was -185.7 (-200.3 to -171.1), representing a 50.1% decrease in patients receiving the chondroitin sulfate plus glucosamine hydrochloride combination, and -186.8 (-201.7 to -171.9), representing a 50.2% decrease, in the celecoxib group. The mean difference at 6 months met the non-inferiority margin (-1.11, 95% CI, -22.0 to -19.8).
At 6 months, WOMAC-rated stiffness decreased by 46.9% in the chondroitin sulfate plus glucosamine hydrochloride group and 49.2% in the celecoxib group (P = .434). WOMAC function score improved in 45.5% and 46.0% of patients, respectively (P = .530). Visual analogue scale (VAS) rated pain declined in 48.0% and 48.8% of patients, respectively (P = .924).
There were no significant differences in patient and physician global assessments of disease activity or response to therapy were evident.
Over 70% of patients in both groups fulfilled the Outcome Measures in Rheumatology- Osteoarthritis Research Society International (OMERACT-OARSI) criteria for treatment response at 120 days, with 6-month response rates of about 80% in both groups.
Joint swelling decreased by over 50% from baseline in both groups: 12.5% to 5.9% for the combination group, and from 14.0% to 4.5% for the celecoxib group.
Use of rescue medication was low and similar in both groups. The type and pattern of adverse events was also similar between the 2 groups.
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