Chondroprotective agents: are we being too dogmatic?

Abstract

Recent major guidelines to osteoarthritis treatment have ceased to recommend the use of chondroprotective drugs; this new standing is based on new data, but comes mostly from a reassessment of existing information through methods of evidence-based medicine; these were more rigorous, with significant changes in the search and inclusion criteria, minimum follow-up requirement and the use of the concept of minimum clinically important improvement. However, currently available data includes a wealth of high quality studies demonstrating long term symptomatic relief and additional benefits such as global efficacy that match results described for non steroidal anti-inflammatory drugs. It is an undisputed concept that osteoarthritis should be managed as an integrated package of care rather than through single treatments, ministered alone or in succession. Thus, when osteoarthritis is in fact managed through any single treatment in order to conduct a controlled trial, it logically follows that it would be difficult to produce significant symptomatic improvements. Moreover, it is well established that positive placebo effects are a significant entity in osteoarthritis research. Therefore, it seems unreasonable to disqualify statistically significant results favoring chondroprotective agents used as monotherapy vs. a powerful placebo and consider them to be "not clinically relevant".We performed a review of the literature and found high quality data showing that chondroprotective agents are safe, effective and decrease the use of non-steroidal anti-inflammatory agents. We therefore suggest that recent guidelines are overly dogmatic.

Effectiveness of Condroprotectors in Treating Osteoarthritis: A Bibliographic Review

“…According to a study by Campos (2014) [4] , chondroprotectors are effective and safe drugs, and for him, other studies and entities that adhere to the disuse of chondroprotectors are totally dogmatic, despite the pharmacology not very clear.…”

Placebo effect in osteoarthritis: Why not use it to our advantage?

“…Controversial treatment modalities such as insoles [34] , viscosupplementation, mind-body therapies, physical therapies and chondroprotective drugs perhaps would not be controversial at all if the only evidence accepted didn't come from methods of evidence-based medicine that are currently very rigorous, with strict inclusion criteria, minimum followup requirement and the use of minimum clinically important improvement concept. It seems unrighteous, for example, to obtain statistically significant results favoring chondroprotective agents used as monotherapy and compared to a powerful placebo and consider it "not clinically relevant" [35] . We are far from treating effectively our OA patients.…”