Abstract

Aim

This study was aimed to assess the efficacy and safety of two oral Symptomatic Slow Acting Drugs for Osteoarthritis (SYSADOAs)—Glucosamine Sulfate, Chondroitin Sulfate, and their combination regimen in the management of knee osteoarthritis (KOA).

Methods

This systematic review was conducted according to PRISMA 2020 guidelines. A detailed literature search was performed from 03/1994 to 31/12/2022 using various electronic databases including PubMed, Embase, Cochrane Library, and Google Scholar, using the search terms—Glucosamine sulfate (GS), Chondroitin sulfate (CS), Knee osteoarthritis, Joint pain, Joint disease, and Joint structure, for literature concerning glucosamine, chondroitin, and their combination in knee osteoarthritis treatment. Cochrane Collaboration’s Risk assessment tool (version 5.4.1) was used for assessing the risk of bias and the quality of the literature. The data was extracted from the included studies and subjected to statistical analysis to determine the beneficial effect of Glucosamine Sulfate, Chondroitin Sulfate, and their combination.

Results

Twenty-five randomized controlled trials (RCTs) were included in this systematic review. In short, exclusively 9 RCTs for GS, 13 RCTs for CS, and 3 RCTs for the combination of GS and CS. All these studies had their treatment groups compared with placebo. In the meta-analysis, CS showed a significant reduction in pain intensity, and improved physical function compared to the placebo; GS showed a significant reduction in tibiofemoral joint space narrowing. While the combination of GS and CS showed neither a reduction in pain intensity, nor any improvement in the physical function. However, the combination exhibited a non-significant reduction in joint space narrowing. In the safety evaluation, both CS and GS have shown good safety profile and were well tolerated.

Conclusion

This meta-analysis revealed that the CS (with decreased pain intensity and improvement in the physical function), and GS (with significant reduction in the joint space narrowing) have significant therapeutic benefits. However, their combination did not significantly improve the symptoms or modify the disease. This may be due to the limited trials that are available on the combination of the sulfate forms of the intervention. Hence, there is a scope for conducting multicentric randomised controlled trials to evaluate and conclude the therapeutic role of CS and GS combination in the management of KOA.

中文翻译：

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硫酸氨基葡萄糖、硫酸软骨素及其联合方案治疗膝骨关节炎的疗效和安全性评价：系统评价和荟萃分析

摘要

目的

本研究旨在评估两种口服症状性慢作用骨关节炎药物 (SYSADOAs)——硫酸氨基葡萄糖、硫酸软骨素及其组合方案在治疗膝骨关节炎 (KOA) 中的有效性和安全性。

方法

本次系统评价是根据 PRISMA 2020 指南进行的。从 1994 年 3 月至 2022 年 12 月 31 日，使用各种电子数据库（包括 PubMed、Embase、Cochrane Library 和 Google Scholar）进行了详细的文献检索，使用检索词——硫酸氨基葡萄糖 (GS)、硫酸软骨素 (CS)、膝关节骨关节炎、关节疼痛、关节疾病和关节结构，有关氨基葡萄糖、软骨素及其组合治疗膝骨关节炎的文献。 Cochrane Collaboration 的风险评估工具（5.4.1 版）用于评估偏倚风险和文献质量。从纳入的研究中提取数据并进行统计分析，以确定硫酸氨基葡萄糖、硫酸软骨素及其组合的有益效果。

结果

本系统评价纳入了 25 项随机对照试验 (RCT)。简而言之，仅 9 项针对 GS 的 RCT，13 项针对 CS 的 RCT，以及 3 项针对 GS 和 CS 组合的 RCT。所有这些研究都将治疗组与安慰剂进行比较。在荟萃分析中，与安慰剂相比，CS 显着降低了疼痛强度，并改善了身体功能； GS 显示胫股关节间隙狭窄显着减少。而 GS 和 CS 的组合既没有显示出疼痛强度的降低，也没有显示出身体功能的任何改善。然而，该组合并没有显着减少关节间隙变窄。在安全性评估中，CS和GS均表现出良好的安全性且耐受性良好。

结论

这项荟萃分析表明，CS（疼痛强度降低和身体功能改善）和 GS（关节间隙狭窄显着减少）具有显着的治疗益处。然而，它们的组合并没有显着改善症状或改变疾病。这可能是由于硫酸盐形式的干预组合的试验有限。因此，开展多中心随机对照试验来评估和总结 CS 和 GS 联合治疗 KOA 的治疗作用是有空间的。