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Subgroup analyses of the effectiveness of oral glucosamine for knee and hip osteoarthritis: a systematic review and individual patient data meta-analysis from the OA trail bank
  1. Jos Runhaar1,
  2. Rianne M Rozendaal1,
  3. Marienke van Middelkoop1,
  4. Hans J W Bijlsma2,
  5. Michael Doherty3,
  6. Krysia S Dziedzic4,
  7. L Stefan Lohmander5,
  8. Timothy McAlindon6,
  9. Weiya Zhang3,
  10. Sita Bierma Zeinstra7
  1. 1Department of General Practice, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
  2. 2Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
  3. 3Department of Rheumatology, The University of Nottingham, Nottingham, UK
  4. 4Department of Primary Care & Health Services, Keele University, Staffordshire, UK
  5. 5Department of Clinical Sciences, Orthopaedics, Lund University, Lund, Sweden
  6. 6Department of Rheumatology, Tufts Medical Center, Boston, Massachusetts, USA
  7. 7Department of General Practice and Orthopaedics, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
  1. Correspondence to Jos Runhaar, Department of General Practice, Erasmus University Medical Center Rotterdam, Erasmus MC, Rotterdam Zuid-Holland, 3000 CA, The Netherlands; j.runhaar{at}erasmusmc.nl

Abstract

Objective To evaluate the effectiveness of oral glucosamine in subgroups of people with hip or knee osteoarthritis (OA) based on baseline pain severity, body mass index (BMI), sex, structural abnormalities and presence of inflammation using individual patient data.

Methods After a systematic search of the literature and clinical trial registries, all randomised controlled trials (RCTs) evaluating the effect of any oral glucosamine substance in patients with clinically or radiographically defined hip or knee OA were contacted. As a minimum, pain, age, sex and BMI at baseline and pain as an outcome measure needed to be assessed.

Results Of 21 eligible studies, six (n=1663) shared their trial data with the OA Trial Bank. Five trials (all independent of industry, n=1625) compared glucosamine with placebo, representing 55% of the total number of participants in all published placebo-controlled RCTs. Glucosamine was no better than placebo for pain or function at short (3 months) and long-term (24 months) follow-up. Glucosamine was also no better than placebo among the predefined subgroups. Stratification for knee OA and type of glucosamine did not alter these results.

Conclusions Although proposed and debated for several years, open trial data are not widely made available for studies of glucosamine for OA, especially those sponsored by industry. Currently, there is no good evidence to support the use of glucosamine for hip or knee OA and an absence of evidence to support specific consideration of glucosamine for any clinically relevant OA subgroup according to baseline pain severity, BMI, sex, structural abnormalities or presence of inflammation.

  • osteoarthritis
  • glucosamine
  • individual patient data
  • meta-analysis
  • subgroups

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Footnotes

  • Handling editor Tore K Kvien

  • Contributors JR, MvM, HJWB, MD, KSD, LSL, TM, WZ and SBZ have substantially contributed to the conception and design of the work. JR and RMR have substantially contributed to the acquisition of the data and drafted the manuscript. All authors contributed to the analysis and interpretation of the work, revised the manuscript critically for important intellectual content, approved the final version of the manuscript and agreed to be accountable for all aspects of the work.

  • Funding The current project received funding by the Dutch Arthritis Foundation (BP12-1-161). KSD is part funded by the National Institute for Health Research (NIHR) Collaborations for Leadership inApplied Research and Care West Midlands and by a Knowledge Mobilisation Research Fellowship (KMRF-2014-03-002) from the NIHR. This paper presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. WZ is supported by a grant from Arthritis Research UK. TEM is supported by grants from Sanofi Aventis, Abbvie, Fidia, Samumed and Pfizer and personal fees from Flexion Therapeutics, Samumed, Plexxikon Inc, Regeneron, Orthogen and McNeil Consumer HC. LSL is supported by personal fees from Galapagos NV, FlexionTherapeutics, Johnson & Johnson, Regeneron, Össur and Samumed.

  • Competing interests None declared.

  • Patient consent Two representatives of patient and public involvement (members of the Arthritis research UK OA Research Users Group) are official members of the Steering Committee of the OA Trial Bank. These representatives provided feedback on the design of the study, including study selection, selection and definitions of subgroups, and outcome measures. Also for dissemination activities of OA Trial Bank and for prioritisation of future research questions, the input from patient and public involvement is obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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