Recent Meta-analysis Proves Structure Modifying Effect of Chondroitin Sulfate

Chondroitin Sulfate , which is widely prescribed for its symptomatic effect in patients with osteoarthritis (OA), has shown to have effect as a structure modifying agent in the management of patients with knee OA, according to a recent meta-analysis published in the October issue of CMRO (Current Medical Research and Opinion).

The authors of the study, lead by Prof. M. Hochberg from the University of Maryland School of Medicine, Baltimore, MD, USA , performed a systematic review and meta-analysis of all available randomized, placebo-controlled trials to determine whether Chondroitin sulfate was a potential structure-modifying agent for patients with OA.

Chondroitin Sulfate belongs to the glycosaminoglycan group and is a major component of the articular cartilage. It has been widely studied as a Symptomatic Slow Acting Drug for osteaoarthritis (SYSADOA) and has been shown to relieve pain and improve mobility in patients with OA. However, its role as a potential structure-modifying agent for OA remains controversial. Agents that may reduce the progressive deterioration of cartilage in OA are called Structure/Disease Modifying Osteaorthritis drugs (S/DMOAD).

The main goal of any OA treatment should be to relieve pain and improve mobility but also limit the progression of joint damage, in other words, the structure/disease modification.

The rate of change in joint space narrowing, a variable derived from serial measurements of joint space width, is the currently accepted biomarker for structural progression in OA.

Four clinical trials were included in the meta-analysis study with a total of 1088 patients with osteoarthritis of the knee. Pooled results demonstrated a small significant effect of chondroitin sulfate on the reduction in rate of decline in minimum joint space width of 0.07 mm/year (95% CI, 0.03, 0.10) that corresponded to an effect size of 0.26 (95% CI, 0.14, 0.38) (p<0.0001).

The main conclusion of this meta-analysis is that, chondroitin sulfate, at the dose of 800 mg orally per day, is effective for slowing the rate of joint space narrowing over a period of up to 2 years and therefore may have a role as a structure-modifying agent in the management of patients with knee OA.

Furthermore, the authors pointed out that in studies that provided data on baseline Kellgren-Lawrence grade (radiological OA scale ranging different severities of the disease), the majority of patients had either possible or mild definite radiographic OA, suggesting that efficacy for structure modification may be limited to or greater in this subgroup. And concluding that because of its safety profile it appears reasonable to administer chondrotin sulfate to patients with mild radiographic knee OA for its possible structural benefit.
These findings confirm the recommendations of the Osteoarthritis Research Society International (OARS) for the use of chondroitin sulfate as a structure-modifying agent in patients with osteoarthritis of the knee.

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