GLUCOSAMINE ET OSTEOARTHRITE

GLUCOSAMINE ET OSTEOARTHRITE
QUESTION : Est-ce que la glucosamine est une thérapie efficace dans
l’ostéoarthrose?
AUTEUR : Mélanie Lecault (OCTOBRE 2007)
P
:
population adulte souffrant d’arthrose
I
:
glucosamine
C
:
placebo
O
:
soulagement des douleurs et maintien de l’autonomie fonctionnelle
CONTEXTE : Plusieurs patients an bureau demandent si la glucosamine est
efficace pour les douleurs « arthritiques ». J’ai senti le besoin d’aller vérifier les
plus récentes évidences à ce sujet.
RECHERCHE :
Cochrane : glucosamine AND arthritis : 10 résultats; 1 pertinent
PubMed : glucosamine AND arthritis (* Limites: études randomisées à double
insu publiées dans les dix dernières années, avec article ou résumé disponible) :
21 résultats avec limites; 2 retenus.
RESULTATS:
1) Towheed TE, Maxwell L, Anastassiades TP, Shea B, Houpt J, Robinson V,
Hochberg MC, Wells G. Glucosamine therapy for treating osteoarthritis.
Cochrane Database of Systematic Reviews 2005, Issue 2.
Background : Osteoarthritis (OA) is the most common form of arthritis, and it is
often associated with significant disability and an impaired quality of life.
Objectives : To review all randomized controlled trials (RCTs) evaluating the
effectiveness and toxicity of glucosamine in OA.
Main results : Analysis restricted to eight studies with adequate allocation
concealment failed to show benefit of glucosamine for pain and WOMAC
function. Collectively, the 20 analyzed RCTs favoured glucosamine with a 28%
(change from baseline) improvement in pain (SMD -0.61, 95% CI -0.95 à 0.28)
and a 21% (change from baseline) improvement in function using the Lequesne
index (SMD -0.51 95% CI -0.96 à 0.05). However, the results are not uniformly
positive, and the reasons for this remain unexplained. WOMAC pain, function
and stiffness outcomes did not reach statistical significance.
In the 10 RCTs in which the Rotta preparation of glucosamine was compared to
placebo, glucosamine was found to be superior for pain (SMD -1.31, 95% CI 1.99 à 0.64) and function using the Lequesne index (SMD -0.51, 95% CI -0.96 à
0.05). Pooled results for pain (SMD -0.15, 95% CI -0.35 à 0.05) and function
using the WOMAC index (SMD 0.03, 95% CI -0.18 à 0.25) in those RCTs in
which a non-Rotta preparation of glucosamine was compared to placebo did not
reach statistical significance. In the four RCTs in which the Rotta preparation of
glucosamine was compared to an NSAID, glucosamine was superior in two, and
equivalent in two. Two RCTs using the Rotta preparation showed that
glucosamine was able to slow radiological progression of OA of the knee over a
three year period (SMD 0.24, 95% CI 0.04 à 0.43).
Glucosamine was as safe as placebo in terms of the number of subjects
reporting adverse reactions (RR=0.97, 95% CI, 0.88 à 1.08).
Authors' conclusions : This update includes 20 studies with 2570 patients. Pooled
results from studies using a non-Rotta preparation or adequate allocation
concealment failed to show benefit in pain and WOMAC function while those
studies evaluating the Rotta preparation show that glucosamine was superior to
placebo in the treatment of pain and functional impairment resulting from
symptomatic OA. WOMAC outcomes of pain, stiffness and function did not show
a superiority of glucosamine over placebo for both Rotta and non-Rotta
preparations of glucosamine. Glucosamine was as safe as placebo.
2) Herrero-Beaumont G, Ivorra JA, Del Carmen Trabado M, Blanco FJ, Benito P,
Martín-Mola E, Paulino J, Marenco JL, Porto A, Laffon A, Araújo D, Figueroa M,
Branco J. Glucosamine sulfate in the treatment of knee osteoarthritis
symptoms: a randomized, double-blind, placebo-controlled study using
acetaminophen as a side comparator. Arthritis Rheum. 2007 Feb;56(2):55567.
OBJECTIVE: To assess the effects of the prescription formulation of
glucosamine sulfate (1,500 mg administered once daily) on the symptoms of
knee osteoarthritis (OA) during a 6-month treatment course. METHODS: Three
hundred eighteen patients were enrolled in this randomized, placebo-controlled,
double-blind trial in which acetaminophen, the currently preferred medication for
symptomatic treatment of OA, was used as a side comparator. Patients were
randomly assigned to receive oral glucosamine sulfate 1,500 mg once daily (n =
106), acetaminophen 3 gm/day (n = 108), or placebo (n = 104). The primary
efficacy outcome measure was the change in the Lequesne index after 6 months.
Secondary parameters included the Western Ontario and McMaster Universities
Osteoarthritis Index (WOMAC) and response according to the Osteoarthritis
Research Society International criteria. These outcome measures were assessed
using an intent-to-treat analysis. RESULTS: At baseline, the study patients had
moderately severe OA symptoms (mean Lequesne index approximately 11
points). Glucosamine sulfate was more effective than placebo in improving the
Lequesne score, with a final decrease of 3.1 points, versus 1.9 with placebo
(difference between glucosamine sulfate and placebo -1.2 [95% confidence
interval -2.3 à 0.8]) (P = 0.032). The 2.7-point decrease with acetaminophen was
not significantly different from that with placebo (difference -0.8 [95% confidence
interval -1.9 à 0.3]) (P = 0.18). Similar results were observed for the WOMAC.
There were more responders to glucosamine sulfate (39.6%) and acetaminophen
(33.3%) than to placebo (21.2%) (P = 0.004 and P = 0.047, respectively, versus
placebo). Safety was good, and was comparable among groups. CONCLUSION:
The findings of this study indicate that glucosamine sulfate at the oral once-daily
dosage of 1,500 mg is more effective than placebo in treating knee OA
symptoms. Although acetaminophen also had a higher responder rate compared
with placebo, it failed to show significant effects on the algofunctional indexes.
3) Clegg DO, Reda DJ, Harris CL, Klein MA, O'Dell JR, Hooper MM, Bradley JD,
Bingham CO 3rd, Weisman MH, Jackson CG, Lane NE, Cush JJ, Moreland LW,
Schumacher HR Jr, Oddis CV, Wolfe F, Molitor JA, Yocum DE, Schnitzer TJ,
Furst DE, Sawitzke AD, Shi H, Brandt KD, Moskowitz RW, Williams HJ.
Glucosamine, chondroitin sulfate, and the two in combination for painful
knee osteoarthritis. N Engl J Med. 2006 Feb 23;354(8):795-808.
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-tosevere knee pain.
4) Reginster JY, Deroisy R, Rovati LC, Lee RL, Lejeune E, Bruyere O, Giacovelli
G, Henrotin Y, Dacre JE, Gossett C. Long-term effects of glucosamine
sulphate on osteoarthritis progression: a randomised, placebo-controlled
clinical trial. Lancet. 2001 Jan 27;357(9252):251-6.
BACKGROUND: Treatment of osteoarthritis is usually limited to short-term
symptom control. We assessed the effects of the specific drug glucosamine
sulphate on the long-term progression of osteoarthritis joint structure changes
and symptoms. METHODS: We did a randomised, double-blind placebo
controlled trial, in which 212 patients with knee osteoarthritis were randomly
assigned 1500 mg sulphate oral glucosamine or placebo once daily for 3 years.
Weightbearing, anteroposterior radiographs of each knee in full extension were
taken at enrolment and after 1 and 3 years. Mean joint-space width of the medial
compartment of the tibiofemoral joint was assessed by digital image analysis,
whereas minimum joint-space width--ie, at the narrowest point--was measured by
visual inspection with a magnifying lens. Symptoms were scored by the Western
Ontario and McMaster Universities (WOMAC) osteoarthritis index. FINDINGS:
The 106 patients on placebo had a progressive joint-space narrowing, with a
mean joint-space loss after 3 years of -0.31 mm (95% CI -0.48 to -0.13). There
was no significant joint-space loss in the 106 patients on glucosamine sulphate: 0.06 mm (-0.22 to 0.09). Similar results were reported with minimum joint-space
narrowing. As assessed by WOMAC scores, symptoms worsened slightly in
patients on placebo compared with the improvement observed after treatment
with glucosamine sulphate. There were no differences in safety or reasons for
early withdrawal between the treatment and placebo groups.
INTERPRETATION: The long-term combined structure-modifying and symptommodifying effects of gluosamine sulphate suggest that it could be a disease
modifying agent in osteoarthritis.
CONCLUSION :
Depuis la revue systématique de Cochrane en 2000, les études montrent des
effets contradictoires. Le plus souvent elles concluent que la glucosamine n’est
pas plus efficace que le placebo pour soulager les douleurs arthritiques.
Plus récemment, on s’intéresse particulièrement aux «disease-modifying effects»
de la glucosamine, avec encore une fois des effets contradictoires. Cependant,
on ne peut éliminer à l’heure actuelle un effet positif sur l’évolution de la maladie.
Pour les patients qui abordent le sujet, je leur dirais qu’il n’a pas été prouvé que
la glucosamine améliore les symptômes, mais que certaines personnes voient
une diminution de leur douleur. Si les patients n’ont pas de contre-indications et
qu’ils ont les moyens de s’offrir la glucosamine, je n’en découragerais pas
l’usage.
.
Informations supplémentaires intéressantes :
La dose utilisée dans les études (1500mg) qui est équivalent à ce qui est écrit
sur les préparations en pharmacie ici (500mg TID).
Rotta : D'apres un petit google c'est un laboratoire : le "Rotta research
laboratorium" . Seulement les produits issus de ce laboratoire contiendraient la
glucosamine sulfate originale. Ces produits ne sont pas disponibles au Canada
mais ils peuvent être postés au Canada à partir des Etats-Unis si on le désire.
Lequesne Index: This includes the measurement of pain (5 questions), walking
distance (1 question), and activities of daily living (4 questions), with versions
available for the hip and knee. Scores for each question are added together to
provide a combined disease severity score. Scores of 1-4 are classified as mild
osteoarthritis, 5- 7 moderate, 8-10 severe, 11-13 very severe, and 14 as
extremely severe osteoarthritis
The WOMAC is a disease-specific, self-administered instrument for patients with
osteoarthritis of the knee or hip. It has 3 separate dimensions (with 24 individual
scenarios), measuring pain (5 scenarios), stiffness (2 scenarios), and physical
function (17 scenarios). It may be administered using a 100 mm/10 cm visual
analog scale (VAS) (where 0 = none, 100 or 10 = extreme) or a Likert scale (0
to 4, where 0 = none, 4 = extreme). These results are then scored on a 0 to 20
scale for pain, a 0 to 8 scale for stiffness, and a 0 to 68 scale for physical
function. Lower scores for both scales indicate a lesser degree of pain, stiffness,
or physical dysfunction