Glucosamine and chondroitin sulfate for the treatment of osteoarthritis: Comment on the article by Akama and Saito

(1,2). Theirpositive criticism of our paper is very much appreciated.They also, however, mentioned some skepticism con-cerning the efcacy of glucosamine and/or chondroitinsulfate treatment, which we were aware of when perform-ing our meta-analysis. One of our major caveats with re-spect to the methodologic quality of the publications in-cluded in the meta-analysis was that none of the trialswere analyzed on an intent-to-treat (ITT) basis. A recentpublication by Mazieres and colleagues (3) showed a pos-itive trend but no signicant changes in Lequesne’s algo-functional index and in pain at rest in patients with kneeosteoarthritis treated with CS compared with placebo,when analyzed on an ITT basis. The completer analysis,however, revealed statistically signicant superior efcacyof CS—results that are very similar to those reported in ourpaper.With respect to the efcacy of glucosamine sulfate (GS),the most recent publication by Reginster and associates (4)has to be noticed: A signicant decrease in joint space nar-rowing in patients treated with GS compared with placebohas been shown during a 3-year period, indicating a disease-modifying capacity of GS for the rst time. Moreover, symp-tomatic efcacy was revealed using the WOMAC index as anoutcome measure. All meta-analyses (2,5) as well as thecontrolled trials mentioned above prove the overall excellenttolerability of CS and GS, even when compared with treat-ment with nonsteroidal antiinammatory drugs (2).In contrast to the United States and apparently Japan,Austria (and most European countries) handles CS as adrug that is available only by prescription; it is currentlynot fully reimbursible by the insurance companies, how-ever. With respect to the symptomatic efcacy, excellenttolerability, and the perspective of a disease-modifyingcapacity (especially for GS), which is indeed of increasingevidence in light of the Reginster trial (4) (trials investigat-ing the same issue for CS are currently underway), oneshould keep this therapeutic option in mind when creatinga therapeutic strategy for osteoarthritis patients. In therecently published European League Against Rheumatismrecommendations for the treatment of knee osteoarthritis,the current position of GS, CS, and other slow-actingsymptomatic drugs in osteoarthritis in the treatment con-cepts seems to be accurately dened (6).Burkhard F. Leeb, MD