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Combined chondroitin sulfate and glucosamine for painful knee osteoarthritis: a multicentre, randomised, double-blind, non-inferiority trial versus celecoxib
  1. Marc C Hochberg1,
  2. Johanne Martel-Pelletier2,
  3. Jordi Monfort3,4,
  4. Ingrid Möller5,
  5. Juan Ramón Castillo6,
  6. Nigel Arden7,8,9,
  7. Francis Berenbaum10,
  8. Francisco J Blanco11,
  9. Philip G Conaghan12,
  10. Gema Doménech13,
  11. Yves Henrotin14,15,
  12. Thomas Pap16,
  13. Pascal Richette17,18,
  14. Allen Sawitzke19,
  15. Patrick du Souich20,
  16. Jean-Pierre Pelletier2
  17. on behalf of the MOVES Investigation Group
  1. 1University of Maryland School of Medicine, Baltimore, Maryland, USA
  2. 2Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada
  3. 3Servei de Reumatologia, Hospital del Mar, Barcelona, Spain
  4. 4IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
  5. 5Instituto Poal de Reumatología, Barcelona, Spain
  6. 6Clinical Pharmacology Unit, Virgen del Rocío University Hospital, Seville, Spain
  7. 7Oxford NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
  8. 8MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
  9. 9Arthritis Research UK, Centre for Sports, Exercise and Osteoarthritis, University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK
  10. 10Department of Rheumatology, Sorbonne University, INSERM UMR S938, UPMC, University of Paris 06, DHU i2B, Assistance Publique—Hôpitaux de Paris, Saint-Antoine Hospital, Paris, France
  11. 11INIBIC-Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
  12. 12Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds & National Institute for Health Research Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
  13. 13Asociación Hipótesis Alternativa (H1), Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
  14. 14Bone and Cartilage Research Unit, Arthropôle Liège, University of Liège, Institute of Pathology, CHU Sart-Tilman, Liège, Belgium
  15. 15Physical Therapy and Rehabilitation Department, Princess Paola Hospital, Marche-en-Famenne, Belgium
  16. 16Institute of Experimental Musculoskeletal Medicine, University Hospital Münster, Münster, Germany
  17. 17Université Paris Diderot, UFR Médicale; Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière, Fédération de Rhumatologie, Paris, France
  18. 18INSERM 1132, Université Paris-Diderot, Hôpital Lariboisière, Paris, France
  19. 19University of Utah School of Medicine, Salt Lake City, Utah, USA
  20. 20Department of Pharmacology, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
  1. Correspondence to Professor Marc C Hochberg, University of Maryland School of Medicine, 10 S. Pine St., MSTF 8-34, Baltimore, MD 21201, USA; mhochber{at}medicine.umaryland.edu

Abstract

Objectives To compare the efficacy and safety of chondroitin sulfate plus glucosamine hydrochloride (CS+GH) versus celecoxib in patients with knee osteoarthritis and severe pain.

Methods Double-blind Multicentre Osteoarthritis interVEntion trial with SYSADOA (MOVES) conducted in France, Germany, Poland and Spain evaluating treatment with CS+GH versus celecoxib in 606 patients with Kellgren and Lawrence grades 2–3 knee osteoarthritis and moderate-to-severe pain (Western Ontario and McMaster osteoarthritis index (WOMAC) score ≥301; 0–500 scale). Patients were randomised to receive 400 mg CS plus 500 mg GH three times a day or 200 mg celecoxib every day for 6 months. The primary outcome was the mean decrease in WOMAC pain from baseline to 6 months. Secondary outcomes included WOMAC function and stiffness, visual analogue scale for pain, presence of joint swelling/effusion, rescue medication consumption, Outcome Measures in Rheumatology Clinical Trials and Osteoarthritis Research Society International (OMERACT-OARSI) criteria and EuroQoL-5D.

Results The adjusted mean change (95% CI) in WOMAC pain was −185.7 (−200.3 to −171.1) (50.1% decrease) with CS+GH and −186.8 (−201.7 to −171.9) (50.2% decrease) with celecoxib, meeting the non-inferiority margin of −40: −1.11 (−22.0 to 19.8; p=0.92). All sensitivity analyses were consistent with that result. At 6 months, 79.7% of patients in the combination group and 79.2% in the celecoxib group fulfilled OMERACT-OARSI criteria. Both groups elicited a reduction >50% in the presence of joint swelling; a similar reduction was seen for effusion. No differences were observed for the other secondary outcomes. Adverse events were low and similarly distributed between groups.

Conclusions CS+GH has comparable efficacy to celecoxib in reducing pain, stiffness, functional limitation and joint swelling/effusion after 6 months in patients with painful knee osteoarthritis, with a good safety profile.

Trial registration number: NCT01425853.

  • Analgesics
  • NSAIDs
  • Osteoarthritis

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