RESEARCH - Glucosamine, Chondroitin Sulfate, and the Two in Combination for Painful Knee Osteoarthritis

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The New England Journal of Medicine

February 23, 2006

Glucosamine, Chondroitin Sulfate, and the Two in Combination for Painful

Knee Osteoarthritis

ABSTRACT

Background Glucosamine and chondroitin sulfate are used to treat

osteoarthritis. The multicenter, double-blind, placebo- and

celecoxib-controlled Glucosamine/chondroitin Arthritis Intervention Trial

(GAIT) evaluated their efficacy and safety as a treatment for knee pain from

osteoarthritis.

Methods We randomly assigned 1583 patients with symptomatic knee

osteoarthritis to receive 1500 mg of glucosamine daily, 1200 mg of

chondroitin sulfate daily, both glucosamine and chondroitin sulfate, 200 mg

of celecoxib daily, or placebo for 24 weeks. Up to 4000 mg of acetaminophen

daily was allowed as rescue analgesia. Assignment was stratified according

to the severity of knee pain (mild [N=1229] vs. moderate to severe [N=354]).

The primary outcome measure was a 20 percent decrease in knee pain from

baseline to week 24.

Results The mean age of the patients was 59 years, and 64 percent were

women. Overall, glucosamine and chondroitin sulfate were not significantly

better than placebo in reducing knee pain by 20 percent. As compared with

the rate of response to placebo (60.1 percent), the rate of response to

glucosamine was 3.9 percentage points higher (P=0.30), the rate of response

to chondroitin sulfate was 5.3 percentage points higher (P=0.17), and the

rate of response to combined treatment was 6.5 percentage points higher

(P=0.09). The rate of response in the celecoxib control group was 10.0

percentage points higher than that in the placebo control group (P=0.008).

For patients with moderate-to-severe pain at baseline, the rate of response

was significantly higher with combined therapy than with placebo (79.2

percent vs. 54.3 percent, P=0.002). Adverse events were mild, infrequent,

and evenly distributed among the groups.

Conclusions Glucosamine and chondroitin sulfate alone or in combination did

not reduce pain effectively in the overall group of patients with

osteoarthritis of the knee. Exploratory analyses suggest that the

combination of glucosamine and chondroitin sulfate may be effective in the

subgroup of patients with moderate-to-severe knee pain. (ClinicalTrials.gov

number, NCT00032890 [ClinicalTrials.gov] .)

http://content.nejm.org/cgi/content/short/354/8/795

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