Stephan Reichenbach, MD; Rebekka Sterchi, MD; Martin Scherer, MD; Sven Trelle, MD; Elizabeth Bürgi, PhD; Ulrich Bürgi, MD; Paul A. Dieppe, MD; Peter Jüni, MD
Acknowledgments: The authors thank Gediminas Matulis for translations, Bettina Lässer for bibliographic work, and Malcom Sturdy for database development.
Grant Support: Drs. Reichenbach and Jüni received grants (no. 4053-40-104762/3 and no. 3200-066378) from the Swiss National Science Foundation's National Research Program 53 on musculoskeletal health and Dr. U. Bürgi received a grant from the Swiss Society of Internal Medicine. Dr. Scherer is supported by a Young Investigators' Award of the German Ministry of Education and Research (grant no. 01 GK 0516). Dr. Jüni was a Program for Social Medicine, Preventive and Epidemiological Research senior research fellow funded by the Swiss National Science Foundation (grant no. 3233-066377).
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Peter Jüni, MD, Department of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012 Bern, Switzerland; e-mail, email@example.com.
Current Author Addresses: Drs. Reichenbach, Trelle, and Jüni and Ms. Sterchi: Universität Bern, Institut für Sozial und Präventivmedizin, Finkenhubelweg 11, 3012 Bern, Switzerland
Dr. Scherer: Georg-August-Universität Göttingen, Abteilung Allgemeinmedizin, 37099 Göttingen, Germany.
Drs. E. Bürgi and U. Bürgi: Inselspital Bern, Klinik und Poliklinik für Innere Medizin, 3010 Bern, Switzerland.
Dr. Dieppe: Department of Social Medicine, University of Bristol, Whiteladies Road, Bristol, BS8 2PR, United Kingdom.
Previous meta-analyses described moderate to large benefits of chondroitin in patients with osteoarthritis. However, recent large-scale trials did not find evidence of an effect.
To determine the effects of chondroitin on pain in patients with osteoarthritis.
The authors searched the Cochrane Central Register of Controlled Trials (1970 to 2006), MEDLINE (1966 to 2006), EMBASE (1980 to 2006), CINAHL (1970 to 2006), and conference proceedings; checked reference lists; and contacted authors. The last update of searches was performed on 30 November 2006.
Studies were included if they were randomized or quasi-randomized, controlled trials that compared chondroitin with placebo or with no treatment in patients with osteoarthritis of the knee or hip. There were no language restrictions.
The authors extracted data in duplicate. Effect sizes were calculated from the differences in means of pain-related outcomes between treatment and control groups at the end of the trial, divided by the pooled SD. Trials were combined by using random-effects meta-analysis.
20 trials (3846 patients) contributed to the meta-analysis, which revealed a high degree of heterogeneity among the trials (I2 = 92%). Small trials, trials with unclear concealment of allocation, and trials that were not analyzed according to the intention-to-treat principle showed larger effects in favor of chondroitin than did the remaining trials. When the authors restricted the analysis to the 3 trials with large sample sizes and an intention-to-treat analysis, 40% of patients were included. This resulted in an effect size of −0.03 (95% CI, −0.13 to 0.07; I2 = 0%) and corresponded to a difference of 0.6 mm on a 10-cm visual analogue scale. A meta-analysis of 12 trials showed a pooled relative risk of 0.99 (CI, 0.76 to 1.31) for any adverse event.
For 9 trials, the authors had to use approximations to calculate effect sizes. Trial quality was generally low, heterogeneity among the trials made initial interpretation of results difficult, and exploring sources of heterogeneity in meta-regression and stratified analyses may be unreliable.
Large-scale, methodologically sound trials indicate that the symptomatic benefit of chondroitin is minimal or nonexistent. Use of chondroitin in routine clinical practice should therefore be discouraged.
Stephan Reichenbach, Rebekka Sterchi, Martin Scherer, Sven Trelle, Elizabeth Bürgi, Ulrich Bürgi, et al. Meta-analysis: Chondroitin for Osteoarthritis of the Knee or Hip. Ann Intern Med. 2007;146:580–590. doi: 10.7326/0003-4819-146-8-200704170-00009
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Published: Ann Intern Med. 2007;146(8):580-590.
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