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Inappropriate claims from non-equivalent medications in osteoarthritis: a position paper endorsed by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO)

Inappropriate claims from non-equivalent medications in osteoarthritis: a position paper endorsed by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO)
Inappropriate claims from non-equivalent medications in osteoarthritis: a position paper endorsed by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO)

Osteoarthritis (OA) is a progressive joint disease, that occurs frequently in the aging population and is a major cause of disability worldwide. Both glucosamine and chondroitin are biologically active molecules that are substrates for proteoglycan, an essential component of the cartilage matrix. Evidence supports the use of glucosamine and chondroitin as symptomatic slow-acting drugs for osteoarthritis (SYSADOAs) with impact on OA symptoms and disease-modifying effects in the long term. Glucosamine and chondroitin are administered in exogenous form as a sulfate salt and multiple formulations of these agents are available, both as prescription-grade products and nutritional supplements. However, while all preparations may claim to deliver a therapeutic level of glucosamine or chondroitin not all are supported by clinical evidence. Only patented crystalline glucosamine sulfate (pCGS) is shown to deliver consistently high glucosamine bioavailability and plasma concentration in humans, which corresponds to demonstrated clinical efficacy. Similarly, clinical evidence supports only the pharmaceutical-grade chondroitin sulfate. The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) advocates, through careful consideration of the evidence base, that judicious choice of glucosamine and chondroitin formulation is essential to maximize clinical benefit, patient adherence and satisfaction with treatment. In future, the ESCEO recommends that complex molecules with biological activity such as pCGS may be treated as “biosimilars” akin to the European Medicines Agency guidance on biological medicinal products. It seems likely that for all other complex molecules classed as SYSADOAs, the recommendation to use only formulations clearly supported by the evidence-base should apply.

Chondroitin sulfate, Glucosamine, Knee, Osteoarthritis, Symptomatic slow-acting drugs for osteoarthritis
1594-0667
111-117
Bruyère, Olivier
ba727e54-ca17-4fa8-be3d-4729fb4b8c0d
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Al-Daghri, Nasser M.
0bf1023c-a104-4f74-8b06-87780dfbd8b4
Dennison, Elaine M.
ee647287-edb4-4392-8361-e59fd505b1d1
Rizzoli, René
c1190577-8164-471d-b90f-6959f92bc25e
Reginster, Jean Yves
33684a35-87f7-4b8d-bb91-4da2b809f855
Bruyère, Olivier
ba727e54-ca17-4fa8-be3d-4729fb4b8c0d
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Al-Daghri, Nasser M.
0bf1023c-a104-4f74-8b06-87780dfbd8b4
Dennison, Elaine M.
ee647287-edb4-4392-8361-e59fd505b1d1
Rizzoli, René
c1190577-8164-471d-b90f-6959f92bc25e
Reginster, Jean Yves
33684a35-87f7-4b8d-bb91-4da2b809f855

Bruyère, Olivier, Cooper, Cyrus, Al-Daghri, Nasser M., Dennison, Elaine M., Rizzoli, René and Reginster, Jean Yves (2017) Inappropriate claims from non-equivalent medications in osteoarthritis: a position paper endorsed by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Aging Clinical and Experimental Research, 30 (2), 111-117. (doi:10.1007/s40520-017-0861-1).

Record type: Review

Abstract

Osteoarthritis (OA) is a progressive joint disease, that occurs frequently in the aging population and is a major cause of disability worldwide. Both glucosamine and chondroitin are biologically active molecules that are substrates for proteoglycan, an essential component of the cartilage matrix. Evidence supports the use of glucosamine and chondroitin as symptomatic slow-acting drugs for osteoarthritis (SYSADOAs) with impact on OA symptoms and disease-modifying effects in the long term. Glucosamine and chondroitin are administered in exogenous form as a sulfate salt and multiple formulations of these agents are available, both as prescription-grade products and nutritional supplements. However, while all preparations may claim to deliver a therapeutic level of glucosamine or chondroitin not all are supported by clinical evidence. Only patented crystalline glucosamine sulfate (pCGS) is shown to deliver consistently high glucosamine bioavailability and plasma concentration in humans, which corresponds to demonstrated clinical efficacy. Similarly, clinical evidence supports only the pharmaceutical-grade chondroitin sulfate. The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) advocates, through careful consideration of the evidence base, that judicious choice of glucosamine and chondroitin formulation is essential to maximize clinical benefit, patient adherence and satisfaction with treatment. In future, the ESCEO recommends that complex molecules with biological activity such as pCGS may be treated as “biosimilars” akin to the European Medicines Agency guidance on biological medicinal products. It seems likely that for all other complex molecules classed as SYSADOAs, the recommendation to use only formulations clearly supported by the evidence-base should apply.

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Accepted/In Press date: 11 November 2017
e-pub ahead of print date: 24 November 2017
Keywords: Chondroitin sulfate, Glucosamine, Knee, Osteoarthritis, Symptomatic slow-acting drugs for osteoarthritis

Identifiers

Local EPrints ID: 417542
URI: https://eprints.soton.ac.uk/id/eprint/417542
ISSN: 1594-0667
PURE UUID: 25426dc2-ee71-4387-bfce-f21ad6b26314
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709
ORCID for Elaine M. Dennison: ORCID iD orcid.org/0000-0002-3048-4961

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Date deposited: 02 Feb 2018 17:30
Last modified: 15 Aug 2019 04:23

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Contributors

Author: Olivier Bruyère
Author: Cyrus Cooper ORCID iD
Author: Nasser M. Al-Daghri
Author: René Rizzoli
Author: Jean Yves Reginster

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