Chondroitin sulfate efficacy versus celecoxib on knee osteoarthritis structural changes using magnetic resonance imaging: a 2-year multicentre exploratory study

Abstract

BackgroundIn osteoarthritis (OA) treatment, although chondroitin sulfate (CS) was found in a number of studies using radiography to have a structure-modifying effect, to date CS use is still under debate. A clinical study using quantitative magnetic resonance imaging (qMRI) is therefore of the utmost importance. Here we report data from a 24-month, randomised, double-blind, double-dummy, controlled, comparative exploratory study of knee OA. The primary endpoint was to determine the effect of CS 1200 mg/day versus celecoxib 200 mg/day on cartilage volume loss (CVL) in the lateral compartment over time as measured by qMRI. Secondary endpoints included assessment of the OA structural changes and signs and symptoms of OA.MethodsqMRI was performed at baseline and at 12 and 24 months. CVL, bone marrow lesion size, and synovial thickness were evaluated using qMRI. The primary statistical analysis was carried out on the modified intention-to-treat (mITT) population (n = 138) using chi-squared, Fisher’s exact, Wilcoxon Mann–Whitney, and Student’s t tests and analysis of covariance. Analyses were also conducted on the according-to-protocol (ATP; n = 120) population.ResultsIn the adjusted mITT analysis, compared with celecoxib treatment, patients treated with CS had a significant reduced CVL at 24 months in the medial compartment (celecoxib –8.1 % ± 4.2, CS –6.3 % ± 3.2; p = 0.018) and medial condyle (–7.7 % ± 4.7, –5.5 % ± 3.9; p = 0.008); no significant effect was seen in the lateral compartment. In the ATP population, CS reduced CVL in the medial compartment at 12 months (celecoxib –5.6 % ± 3.0, CS –4.5 % ± 2.6; p = 0.049) and 24 months (celecoxib –8.4 % ± 4.2, CS –6.6 % ± 3.3; p = 0.021), and in the medial condyle at 24 months (celocoxib –8.1 % ± 4.7, CS –5.7 % ± 4.0; p = 0.010). A trend towards a statistically reduced synovial thickness (celecoxib +17.96 ± 33.73 mm, CS –0.66 ± 22.72 mm; p = 0.076) in the medial suprapatellar bursa was observed in CS patients. Both groups experienced a marked reduction in the incidence of patients with joint swelling/effusion and in symptoms over time. Data showed similar good safety profiles including cardiovascular adverse events for both drugs.ConclusionThis study demonstrated, for the first time in a 2-year randomised controlled trial using qMRI, the superiority of CS over celecoxib at reducing CVL in knee OA patients.Trial registrationClinicalTrials.gov NCT01354145. Registered 13 May 2011.Electronic supplementary materialThe online version of this article (doi:10.1186/s13075-016-1149-0) contains supplementary material, which is available to authorized users.

Efficacy of Chondroitin Sulfate for Painful Knee Osteoarthritis: A One-Year, Randomized, Double-Blind, Multicenter Clinical Study in Japan

“…We anticipate that magnetic resonance imaging will serve as a better tool for detecting such effects of CS treatment in future studies. 30,61) In conclusion, we demonstrated oral treatment with sodium CS is tolerable, and that a dose of 1560 mg/d is more effective than 260 mg/d for pain relief in patients with knee OA. However, it was notable that this difference was only present for the subgroup of patients with severe symptoms.…”

“…[4][5][6][7][28][29][30][31] Recently, various biomarkers have been developed to detect the articular alterations in OA, and accumulating evidence suggests that there are associations with changes in ECM protein components in the cartilage and synovium as disease progresses in knee OA. 45,46) Finding the level of COMP in serum allows defining the degree of cartilage damage in OA 47,48) and observing effectiveness of the treatment.…”

“…[25][26][27] Furthermore, the clinical efficacy of CS has been shown in improving OA joint function and in reducing cartilage destruction. [4][5][6][7][28][29][30] Singh et al recently conducted a review of randomized trials of OA interventions in the Cochrane Database of Systemic Reviews and concluded that CS may improve pain, that it probably improves QOL, and that it probably slows down narrowing of the joint space in patients with knee OA. 31) However, there have also been reports showing no effects of CS on pain or cartilage structure.…”

Molecular effects of chondroguard in osteoarthritis and herniated discs

“…(Испания) [64][65][66]. Показано, что при приеме внутрь (1200 мг/сут, внутрь, 24 мес) эффективность лечения паци-ентов с ОА коленных суставов была сравнимой с таковой при использовании нестероидного противовоспалительно-го препарата целекоксиба (200 мг/сут, n=62).…”

Nutrition and dietary supplements in the prevention of osteoarthritis

“…Međutim, neophodan je veći broj kvalitetno dizajniranih kliničkih ispitivanja kako bi se utvrdio klinički značaj suplementacije hondroitin-sulfatom (52). U pogledu strukturno-modifikujućih efekata, nedavna studija Pelletier i sar., pokazala je da je primena hondroitin-sulfata (1200 mg/dan) tokom 24 meseca, efikasnija u odnosu na celokoksib u pogledu usporavanja gubitka artikularne hrskavice kolena, praćeno kvantitativnom magnetnom rezonancom (qMRI) (53).…”