Meta-analysis finds little benefit from using chondroitin for OA knee or hip pain

Chondroitin may have a clinically relevant effect in patients with low-grade osteoarthritis, but a randomized, controlled trial is needed address the possibility.

Chondroitin sulfate has little effect on knee or hip osteoarthritis pain, according to the findings of a new meta-analysis of published studies.

"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," the study authors wrote.

Stephan Reichenbach, MD, and colleagues in Bern, Switzerland, as well as several other centers in Europe, conducted a thorough review of published randomized or quasi-randomized and controlled trials that compared treatment with chondroitin to either placebo or no intervention. The review focused on patients with osteoarthritis (OA) of either the knee or hip and excluded trials evaluating doses of chondroitin less than 400 mg/d, according to the study, published in Annals of Internal Medicine.

Overall, the literature search identified 1,453 references. Of these, the researchers considered 291 studies to be eligible, but only 22 trials involving 4,056 total patients met the criteria for inclusion in the meta-analysis. This included 17 full-text journal articles and five trials published only as conference abstracts.

Chondroitin dosages were reported in 20 of the 22 trials and averaged 1,000 mg/d, ranging from 800 mg/d to 2,000 mg/d. All trials allowed the concomitant use of pain medication, according to the study.

"Our meta-analysis of trials comparing chondroitin with placebo or a nonintervention control revealed a high degree of heterogeneity among trials, which made the interpretation of results difficult," the authors wrote.

"As with any systematic review, our study is limited by the quality of included trials. Most trials had poor methodological quality or inadequate reporting. Only two trials described how allocation of patients was concealed, and only three trials seemed to have been analyzed according to the intention-to-treat principle," they reported.

Of the trials reviewed, the larger, more recent and methodologically sound trials found almost no effect from chondroitin. However, these trials tended to include fewer patients with low-grade OA compared to earlier, smaller trials, which found moderate-to-large effects from treatment. These earlier trials also tended to use lower-quality methodology, according to the meta-analysis.

"Although we deem it unlikely that patients with advanced [OA] will benefit, we cannot exclude a clinically relevant effect of chondroitin in patients with low-grade [OA]. A rigorously designed, adequately powered, randomized placebo-controlled trial restricted to patients with low-grade [OA] would be required to address this," the authors wrote.

For more information:
Reichenbach A, Sterchi R, Scherer M, et al. Meta-analysis: Chondroitin for osteoarthritis of the knee or hip. Ann Intern Med. 2007;146:580-590.