Current issueswhich included the government's commitment to ensuring that Quality, Innovation, Productivity and Prevention (QIPP) supports the NHS to make efficiency savings. Table 1 sets out the author's QIPP assessment of the use of glucosamine sulphate in OA. Other assessmentsThe Scottish Medicines Consortium (SMC) in 2008 did not recommend glucosamine hydrochloride for use within NHS Scotland. 9 However, it should be noted that this was specifically for glucosamine hydrochloride and this concurs with the NICE guidance, which details that there is no evidence of effectiveness for this salt.In 2009 there was a Health Technology Assessment completed for glucosamine. 10 The review again recognised the superiority of glucosamine sulphate over glucosamine hydrochloride and the statistical significance of the findings for glucosamine sulphate.The update of the Cochrane review of glucosamine in 2009 1 demonstrated pain reduction, improvements in markers related to the severity of OA (and improvements in those related to the severity of arthritis) all in favour of glucosamine sulphate, and statistically more favourable than the previous review in 2005. 11 This 2005 Cochrane review is one of the reviews used by the Drug and Therapeutics Bulletin (DTB) in 2008, 12 which demonstrated that there was a significantly larger effect size for glucosamine sulphate than glucosamine hydrochloride. The DTB also reiterated the NICE recommendation that only a once-daily dose of 1500mg of glucosamine sulphate should be used, but again their review predated the availability of a licensed product in the UK and so could not recommend its use for the NHS at that time.A more recent meta-analysis was published in 2010. 13 Unfortunately studies using both glucosamine sulphate and hydrochloride and OA of the knee and hip were pooled resulting in a dilution of the beneficial effect of glucosamine, for which the meta-analysis has been criticised. 14 Even so, the metaanalysis still demonstrated a statistically significant benefit for glucosamine sulphate.The authors' conclusion that patients who perceive a benefit www.prescriber.co.uk 34 Prescriber 5 June 2011 Table 1. The author's QIPP assessment of glucosamine sulphate in OA Quality A licensed glucosamine sulphate preparation (Glusartel) has recently been made available in the UK. The MHRA reiterated in 2008 4 that licensed products available in the UK should be used wherever possible, even for off-label use. Prescribing a licensed glucosamine sulphate medicine over an unlicensed preparation ensures that the patient receives a drug that is up to standard in pharmaceutical quality terms to treat their disease. The quality of unlicensed glucosamine preparations, being prescribed on the NHS, cannot be guaranteed. InnovationThe availability of a licensed nutraceutical is an innovation for the UK prescription-only medicine market. It is important, however, to note that the evidence from trials and meta-analyses is that the benefit is obtained from crystalline glucosamine sulphate at the dose ...
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