Chondroitin sulfate as good as celecoxib for knee OA
medwireNews: Results of a randomized trial suggest that pharmaceutical-grade chondroitin sulfate (CS) is as effective as the non-steroidal anti-inflammatory drug (NSAID) celecoxib for reducing pain and improving function among patients with symptomatic knee osteoarthritis (OA).
“This formulation of CS should be considered a first-line treatment in the medical management of knee OA,” say Jean-Yves Reginster (Liège State University, Belgium) and study co-authors.
The CONCEPT (Chondroitin versus Celecoxib versus Placebo Trial) team randomly assigned 604 patients older than 50 years of age to receive once daily treatment with either 800 mg CS, 200 mg celecoxib, or placebo, and found that patients receiving CS or celecoxib experienced a significantly greater reduction in pain and disease severity scores over 6 months of treatment compared with those receiving placebo.
Patients in the CS group experienced a decrease in Visual Analogue Scale scores from a mean of 71.2 mm at baseline to 28.6 mm at the 6-month follow-up, while those receiving celecoxib experienced a reduction from 70.0 to 30.5 mm, compared with a reduction from 70.2 to 36.8 mm in the placebo group.
The mean Lequesne Index score decreased from 11.8 points at baseline to 7.1 points at the 6-month follow-up among participants receiving CS and from 11.6 to 7.0 points among those receiving celecoxib, compared with a reduction from 11.8 to 8.0 points for the placebo group.
Furthermore, a greater proportion of patients in the CS and celecoxib groups achieved the Minimal-Clinically Important Improvement (the smallest change in measurement that signifies an important improvement in a patient’s symptom) and the Patient-Acceptable Symptom State (the value of symptoms beyond which patients consider themselves well) than those receiving placebo.
These findings suggest that “CS is superior to placebo and similar to celecoxib across multiple outcome measures,” and support “a durable therapeutic benefit” of symptomatic slow-acting drugs for OA, say the researchers in the Annals of the Rheumatic Diseases.
There were no significant differences in the rates of treatment-emergent adverse events (TEAEs), serious adverse events, adverse drug reactions (ADR), and withdrawal related to TEAEs between the three treatment groups. The most commonly reported ADR was abdominal pain/discomfort, experienced by 2.5% of participants in the CS group, 4.5% in the celecoxib group, and 2.9% in the placebo group.
“[W]e confirmed the excellent safety profile of CS that has been previously observed by others,” note Reginster et al.
And the team concludes: “This compelling benefit-risk profile, in light of the known clinical risks associated with chronic usage of NSAIDs and paracetamol, underscores the potential importance of pharmaceutical-grade CS in the management of knee OA, especially in this older population requiring long-term treatment.”
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