MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

I am constantly on the look-out for good studies of alternative medicine, particularly those that yield positive findings. The trouble is that there aren’t many of those; studies tend to be either good or positive. Could this one be an exception?

The aim of this brand-new trial was to determine, if  dietary supplements of glucosamine and/or chondroitin, result in reduced joint space narrowing (JSN) and pain in patients with knee osteoarthritis. It was designed as a  double-blind randomised placebo-controlled clinical trial with 2-year follow-up. 605 participants, aged 45–75 years, reporting chronic knee pain and with evidence of medial tibio-femoral compartment narrowing (but retaining >2 mm medial joint space width) were randomised to once daily: glucosamine sulfate 1500 mg (n=152), chondroitin sulfate 800 mg (n=151), both of these dietary  supplements (n=151) or placebo capsules (n=151). JSN (mm) over 2 years was measured from digitised knee radiographs. Maximum knee pain (0–10) was self-reported in a participant diary for 7 days every 2 months over 1 year.

The results indicate that, after adjusting for factors associated with structural disease progression (gender, body mass index (BMI), baseline structural disease severity and Heberden’s nodes), allocation to the dietary supplement combination (glucosamine–chondroitin) resulted in a statistically significant (p=0.046) reduction of 2-year JSN compared to placebo: mean difference 0.10 mm (95% CI 0.002 mm 0.20 mm); no significant structural effect for the single treatment allocations was detected. All 4 groups demonstrated reduced knee pain over the first year, but no significant between-group differences (p=0.93) were detected. 34 (6%) participants reported possibly-related adverse medical events over the 2-year follow-up period.

The authors drew the following conclusions: allocation to the glucosamine–chondroitin combination resulted in a statistically significant reduction in JSN at 2 years. While all allocation groups demonstrated reduced knee pain over the study period, none of the treatment allocation groups demonstrated significant symptomatic benefit above placebo.

This study has many strengths: it addresses a relevant research question, has a sufficiently large sample size, includes a long follow-up, and is well reported. So, it is a good study of an alternative therapy that is used by many patients. But did it really produce a positive result, i.e. findings which suggest that the tested treatments are effective? The answer seems ‘yes and no’. The combined, regular intake of both supplements caused less joint space narrowing which is a good objective sign of reduced disease activity. However, this was not paralleled by a reduction in pain that was better than that on placebo.

So, if you are a fan of glucosamine/chondroitin supplements, you will be pleased with this study, but if you are not in favour of such medications or do not have the spare cash to afford the considerable costs, you might say: I told you, they are pretty useless!

4 Responses to Finally an encouraging result from a trial of alternative medicine?

  • The right question is not about opinion. The right question should be do we have better alternatives with less side effects? Probably not. Mr. Ernst goes one again opinion side when it’s usefull for him and pharma industry. If glucosamine is the best option, why not to recommend it?

    • but is it the best option?
      as far as I know, it isn’t – see also my next post.

    • The alternative to this supplement is: nothing. Symptomatic relief (i.e. painkillers) is still required, as there is no change in pain scores, so the only difference is a small reduction in JSN in patients who would normally not be on any medication to mitigate JSN.

      As Prof. Ernst says, it is an underwhelming result, and it resoundingly fails to match the hype of those promoting these supplements.

      Don’t forget, the Supplements, Complementary and Alternative Medicine (SCAM) industry is a multi-billion-dollar industry, and many SCAM manufacturers are not only not different fomr “big pharma”, several of them are actually wholly owned subsidiaries of “big pharma”.

      Skeptics, including Prof. Ernst, argue for a level playing field. If you think we’re not critical of “big pharma” then you’ve not been listening. The All Trials initiative is a grass-roots campaign coneived and led by prominent skeptics, and it has the potential to achieve more improvement in “big pharma” than all the whining of all the quacks in history!

      • Mr. Chapman sums up the situation brilliantly.

        I would only ask if there is any scientific basis for even thinking these supplements COULD work–is there even a premise?

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