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I read with great interest the article by Reginster and colleagues1 regarding the effectiveness of chondroitin sulfate (CS) in the treatment of symptomatic knee osteoarthritis (OA). This randomised, double-blind trial demonstrated that pharmaceutical-grade CS is superior to placebo and equivalent to celecoxib in reducing pain and improving function over 6 months in patients with symptomatic knee OA, indicating that this formulation of CS should be considered a first-line treatment in the management of knee OA1. The results of Reginster et al are in agreement with a recent systematic review conducted by the Cochrane Group, which showed that CS, alone or in combination with GS, is better than placebo in improving pain in patients with OA, as reported in short-term studies.2 However, there are some noteworthy issues in this regard. First, the duration of the study for the symptomatic treatment of knee OA is relatively short. In addition, published studies regarding the efficacy of CS in knee OA beyond the 6-month duration are sparse. Long-term prospective studies, ideally those performed over 2 or 3 years or more, are warranted.3 Second, CS is most commonly used in combination with glucosamine sulfate (GS) to treat OA. However, a recent randomised, double-blind, placebo-controlled study has failed to demonstrate the superiority of CS/GS combination therapy over placebo in terms of reducing joint pain and functional impairment in patients with symptomatic knee OA over 6 months.4 Third, CS is available as pharmaceutical-grade and nutraceutical-grade products. The results of this study were obtained using prescription drugs containing highly purified CS produced by pharmaceutical companies. Since nutraceutical-grade products are known to show marked variations in their preparation, composition, content and purity, this result should not be extrapolated to nutraceutical-grade products. Although I respect the work done by the authors, I am unsure whether the use of CS in routine clinical practice should be encouraged. Considering that medication for OA is usually taken for a long time, the findings of this study must be confirmed by a long-term trial. I am looking forward to further evaluation to clarify the efficacy of this agent in long-term trials.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.