David T. Felson, MD, MPH; Timothy McAlindon, MD, MPH
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Felson DT, McAlindon T. Osteoarthritis: New Insights. Ann Intern Med. 2002;136:88. doi: 10.7326/0003-4819-136-1-200201010-00019
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Published: Ann Intern Med. 2002;136(1):88.
As coauthors of the review of therapy in osteoarthritis who are not funded by companies producing COX-2 inhibitors or any brands of glucosamine or chondroitin, we can comment impartially on Dr. Lindow's concerns about any bias in advocating COX-2 inhibitors compared with glucosamine or chondroitin. We consider glucosamine and chondroitin promising agents for osteoarthritis. Our meta-analysis of trials of these agents suggested several biases, including probable publication bias, that should inject caution into interpretation of the positive trial results. We should note that since the publication of our meta-analysis, several new randomized, placebo-controlled trials have been published that have not shown efficacy of either glucosamine or chondroitin (1-3). An additional null trial was presented at the 2000 American College of Rheumatology meeting. We know of no published or unpublished data suggesting that COX-2 inhibitors have no significant effect relative to placebo in patients with osteoarthritis. Furthermore, COX-2 inhibitors underwent critical scrutiny by the U.S. Food and Drug Administration before approval; glucosamine and chondroitin have not been so evaluated. Thus, we believe that there is stronger evidence for relief of symptoms in osteoarthritis with COX-2 inhibitors than with glucosamine and chondroitin, for which the data are genuinely conflicting. It is to be hoped that the large National Institutes of Health–funded trial of glucosamine and chondroitin will help definitively resolve the issue of their place in osteoarthritis management. We concur with Dr. Lindow that these agents are safe and did not mean to imply that COX-2, glucosamine, or chondroitin clearly affects structural disease progression. However, such an effect for glucosamine has recently been suggested by a large-scale, long-term randomized trial.
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