Most Read Articles
01 Oct 2013

Heart disease is still New Zealand’s biggest killer, with one Kiwi dying from coronary heart disease every 90 minutes. Pharmacy Today New Zealand looks at how pharmacists can help

Pearl Toh, 11 Oct 2017
Clinical practice is an art guided by good science, and clinical practice guideline (CPG) is meant to guide in integrating the art and science of clinical practice for the long-term benefits of patients, said Dr Abdul Rashid Abdul Rahman, a consultant cardiovascular physician at An-Nur Specialist Hospital in Bangi, Malaysia, during the 13th Asian-Pacific Congress of Hypertension (APCH) held in Singapore.
Dr. James Salisi, 01 Jul 2014

The recent spike in the number of new cases of human immunodeficiency virus (HIV) infection in the Philippines means that clinicians and pharmacists alike may need to increase their awareness and competency in prescribing and monitoring HIV treatment. Although taught in medical and pharmacy schools, the scarcity in exposure to clinical cases before highlights the need to for physicians and pharmacist to review HIV pharmacotherapy in order to cater to the increasing HIV patient population.

01 Sep 2017
Complementary medicines can play an important part in maintaining wellness, preventing deficiencies and optimizing health outcomes, says Dr Lesley Braun PhD, Director of the Blackmores Institute. 

Chondroitin sulfate as effective as celecoxib for symptomatic knee osteoarthritis

Audrey Abella
10 Oct 2017

The SYSADOA* chondroitin sulfate was as effective as the NSAID** celecoxib and superior to placebo in reducing pain and improving function for over 6 months in patients with symptomatic knee osteoarthritis (OA), according to the CONCEPT*** trial.

In this prospective, multicentre, double-blind trial, 604 patients with primary knee OA were randomized to receive chondroitin sulfate 800 mg (n=199), celecoxib 200 mg (n=200), or placebo (n=205) once daily for 6 months. Participants were evaluated using the Visual Analogue Scale (VAS) and Lequesne Index (LI) and followed for 182 days. [Ann Rheum Dis 2017;76:1537-1543]

Analysis of VAS and LI scores revealed significant improvement across all treatment arms compared with baseline as early as day 30 (p<0.001 for all).

At day 182, improvement in VAS and LI persisted in the chondroitin sulfate (-42.6 mm; p=0.001 and -4.7; p=0.023, respectively) and celecoxib arms (-39.5 mm; p=0.009 and -4.6; p=0.015, respectively) compared with placebo (-33.3 mm and -3.7, respectively).

Of note was the decrease in LI observed in the celecoxib arm at day 30, which only became apparent in the chondroitin sulfate arm at day 91 (p=0.045 and 0.050, respectively, compared with placebo). “[T]his observation may be related to an intrinsic difference in the mechanism of action of the molecules [of the two active drugs],” said the researchers.

Despite significant improvement in pain and function across all treatment arms as early as one month into treatment, the parallel findings between chondroitin sulfate and celecoxib at treatment end highlight the former’s excellent efficacy profile, noted the researchers.

Abdominal pain/discomfort was the most frequent adverse event across all treatment arms (2.5, 4.5, and 2.9 percent in the chondroitin sulfate, celecoxib, and placebo arms, respectively). Apart from one case of thrombocytopenia and one of leukopenia in the placebo group, no significant toxicities were reported in the chondroitin sulfate group, reflecting its safety, noted the researchers.

“[The combined] therapeutic effect and well-documented safety and tolerability explain why recent guidelines recommend SYSADOAs, including pharmaceutical-grade [chondroitin sulfate], as a first-line treatment in the management of knee OA … especially in [the] older population requiring long-term treatment,” said the researchers.

Furthermore, SYSADOAs counter the clinical risks associated with chronic acetaminophen and NSAID use despite their proven efficacy for OA, [Semin Arthritis Rheum 2016;45(4 Suppl):S3-S11; Ann Rheum Dis 2016;75:552-559; Lancet 2016;387:2093-2105] with previous findings showing a higher effect size for pain with chondroitin sulfate vs acetaminophen (0.35 vs 0.14). [Semin Arthritis Rheum 2014;44:253-263]

The researchers acknowledged the need for future clinical guidelines on the pharmacological management of knee OA, which warrants significant attention given the associated functional impairment that may eventually lead to disability. [Best Pract Res Clin Rheumatol 2006;20:3-25; Br Med Bull 2013;105:185-199]

 

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Most Read Articles
01 Oct 2013

Heart disease is still New Zealand’s biggest killer, with one Kiwi dying from coronary heart disease every 90 minutes. Pharmacy Today New Zealand looks at how pharmacists can help

Pearl Toh, 11 Oct 2017
Clinical practice is an art guided by good science, and clinical practice guideline (CPG) is meant to guide in integrating the art and science of clinical practice for the long-term benefits of patients, said Dr Abdul Rashid Abdul Rahman, a consultant cardiovascular physician at An-Nur Specialist Hospital in Bangi, Malaysia, during the 13th Asian-Pacific Congress of Hypertension (APCH) held in Singapore.
Dr. James Salisi, 01 Jul 2014

The recent spike in the number of new cases of human immunodeficiency virus (HIV) infection in the Philippines means that clinicians and pharmacists alike may need to increase their awareness and competency in prescribing and monitoring HIV treatment. Although taught in medical and pharmacy schools, the scarcity in exposure to clinical cases before highlights the need to for physicians and pharmacist to review HIV pharmacotherapy in order to cater to the increasing HIV patient population.

01 Sep 2017
Complementary medicines can play an important part in maintaining wellness, preventing deficiencies and optimizing health outcomes, says Dr Lesley Braun PhD, Director of the Blackmores Institute.