Differentiation of patented crystalline glucosamine sulfate from other glucosamine preparations will optimize osteoarthritis treatment

Abstract

Symptomatic slow-acting drugs for osteoarthritis (SYSADOAs) are recommended for the medium- to long-term management of knee osteoarthritis (OA) due to their abilities to control pain, improve function and delay joint structural changes. Among SYSADOAs, evidence is greatest for the patented crystalline glucosamine sulfate (pCGS) formulation (Mylan). Glucosamine is widely available as glucosamine sulfate (GS) and glucosamine hydrochloride (GH) preparations that vary substantially in molecular form, pharmaceutical formulation and dose regimen. Only pCGS is given as a highly bioavailable once-daily dose (1500 mg), which consistently delivers the plasma levels of around 10 μmol/L required to inhibit interleukin-1-induced expression of genes involved in the pathophysiology of joint inflammation and tissue destruction. Careful consideration of the evidence base reveals that only pCGS reliably provides a moderate effect size on pain that is higher than paracetamol and equivalent to non-steroidal anti-inflammatory drugs (NSAIDs), while non-crystalline GS and GH fail to reach statistical significance for pain reduction. Chronic administration of pCGS has disease-modifying effects, with a reduction in need for total joint replacement lasting for 5 years after treatment cessation. Pharmacoeconomic studies of pCGS demonstrate long-term reduction in additional pain analgesia and NSAIDs, with a 50% reduction in costs of other OA medication and healthcare consultations. Consequently, pCGS is the logical choice, with demonstrated medium-term control of pain and lasting impact on disease progression. Physician and patient education on the differentiation of pCGS from other glucosamine formulations will help to improve treatment selection, increase treatment adherence, and optimize clinical benefit in OA.

Symptomatic Efficacy of Pharmacological Treatments for Knee Osteoarthritis: A Systematic Review and a Network Meta-Analysis with a 6-Month Time Horizon

“…We also observed a large heterogeneity across studies in the tools that were used to report this outcome, making its assessment poorly reliable. Our results reporting a reduction in JSN with pCGS and with pCS are in perfect accordance with previous publications showing that pCGS [45,46] or pCS [47] are able to significantly prevent structural progression of osteoarthritis. However, in the context of the present investigation, these analyses should be interpreted with caution because the time-horizon selected for our NMA was 6 months.…”

Controversias con los medicamentos sintomáticos de acción lenta para la Osteoartritis (SYSADOAs)

“…Diferentes estudios clínicos, revisiones sistemáticas, metanálisis y opiniones de expertos coinciden en que el clorhidrato de glucosamina es ineficaz en controlar el dolor en la osteoartritis [32,33,34,35]. Sobre este aspecto es importante comentar uno de los estudios clínicos más contradictorios con glucosamina.…”

2019 revised algorithm for the management of knee osteoarthritis: the Southeast Asian viewpoint

“…Therefore, in 2019, a new algorithm [13] was published taking into account the recent evidence on efficacy and safety of medications commonly used for knee OA and the GRADE (Grading of Recommendations Assessment, Development and Evaluation) process was added, to better highlight the evidence used in the algorithm in a transparent and systematic way [14]. Since 2014, the ESCEO algorithm has been well-received worldwide and endorsed by many national societies with a consequent translation, adaptation to the local context, and publication in several countries including China, Russia, Central Europe and Southeast Asia [15][16][17][18][19][20]. For this reason, a working group (WG) was formed between members of the international ESCEO task force (N.V., J.M.K., and J.-Y.R.)…”