Does glucosamine need to be taken with chondroitin to be effective?

1.

Elsevier ClinicalKey Drug Monograph

Content last updated: September 5, 2023.

Description Glucosamine is sold as a non-prescription dietary supplement; it is currently not classified as a drug by the FDA. Some commercial products contain glucosamine in combination with chondroitin. Several clinical studies have documented the efficacy of glucosamine in the treatment of patients with osteoarthritis: data from double-blind studies showed glucosamine was superior to placebo and to ibuprofen in patients with osteoarthritis of the knee. Although there is some logic for administering glucosamine in combination with chrondroitin, there is currently no evidence that the combination is more effective than glucosamine alone for osteoarthritis. While glucosamine is a simple, 6-carbon structure, chondroitin is much larger molecule and there is concern that the oral bioavailability of chondroitin is too low to exert any beneficial effect. Clinical data indicate that glucosamine is beneficial after intramuscular, intraarticular, or oral administration. Jason Theodosakis, MD, has published The Arthritis Cure , a book describing both glucosamine and chondroitin; this book mixes factual information with anecdotal information. Data from a randomized, placebo-controlled, double-blind study of 202 patients evaluated the effects of glucosamine on disease progression and supported the use of glucosamine long-term (3 years) for slowing progression of knee osteoarthritis.

2.

Elsevier ClinicalKey Drug Monograph

Content last updated: February 5, 2024.

Description Although there is some logic for combining chondroitin and glucosamine, it is not clear if the combination is more effective than glucosamine alone for osteoarthritis. Most data have come from trials of osteoarthritis (OA) of the knee, and have compared the supplements to treatment with NSAIDs, placebo or both; some trials have shown non-inferiority to celecoxib, but many trials have not lasted beyond 6 months. Conflicting data regarding efficacy has led to some guidelines supporting positive statements in use, and others recommending against use in OA. The American College of Rheumatology (2012) has recommended against use in OA due to the controversial efficacy of the supplements alone or in combination. Despite conflicting data, many experts continue to be interested in chondroitin or glucosamine, alone or in combination, in the first-line treatment of osteoarthritis, due to the toxicities of traditional treatments such as non-steroidal antiinflammatory agents (NSAIDs), particularly in the aging population.

Indications And Dosage **For use as a cartilage matrix enhancer in patients with osteoarthritis†** Oral dosage (general dosage recommendations) Adults: Dosage not established; common dose regimens contain 400 to 800 mg chondroitin with 500 to 1,000 mg glucosamine PO given 2 to 3 times per day; adjust maintenance to lowest effective dosage. CLINICAL DATA: Most data have come from trials of osteoarthritis (OA) of the knee. Conflicting efficacy data has led to some guidelines supporting positive statements in use, and others, such as the American College of Rheumatology (2012), recommending against use in OA at this time. The multicenter, double-blind, placebo- and celecoxib-controlled Glucosamine/chondroitin Arthritis Intervention Trial (GAIT) (n = 1,583) evaluated glucosamine and chondroitin efficacy and safety as a treatment for knee pain from OA for 6 months.Receipt of glucosamine 500 mg and chondroitin sulfate 400 mg PO 3 times daily for 6 months led to a similar percentage of patients with a 20% decrease in the WOMAC pain score (66.6%) as compared with placebo recipients (60.1%) and celecoxib 200 mg PO daily recipients (70.1%). Most of the patients had mild pain. Among patients with moderate-to-severe pain (n = 70), 79.2% met the primary endpoint with glucosamine and chondroitin, whereas 54.3% of placebo recipients and 69.4% of celecoxib recipients did, suggesting this subgroup might find glucosamine-chrondroitin effective. However, a 2-year extension of the GAIT study did not find clinically significant differences in the use of chondroitin-glucosamine, celecoxib or placebo in treating these patients.

Indications And Dosage However, a 2-year extension of the GAIT study did not find clinically significant differences in the use of chondroitin-glucosamine, celecoxib or placebo in treating these patients. Another multicenter study reported the combination was not superior to placebo after 6 months of treatment in patients with OA of the knee. It is not clear if the combination is more effective than either agent alone for osteoarthritis. Use of pharmaceutical grade chondroitin (800 mg/day) has been studied in comparison to celecoxib and placebo in patients with osteoarthritis (OA) of the knee; both chondroitin and celecoxib were superior to placebo in function scores at 3 months and in pain-relief at 6 months, with no difference between the 2 active treatment groups. Another study found non-inferiority in comparison to celecoxib. Oral dosage (Cosamin-DS tablets) Adults: Dietary supplement label: Take 3 capsules or caplets (each capsule or caplet contains 500 mg of glucosamine with 400 mg of chondroitin) PO daily until desired comfort is reached. May reduce number of capsules taken daily to maintain comfort level. May take the daily dose all at once or divided with meals.