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Inappropriate claims from non-equivalent medications in osteoarthritis: a position paper endorsed by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO).

Abstract

Osteoarthritis (OA) is a progressive joint disease, that occurs frequently in the aging population and is a major cause of disability worldwide. Both glucosamine and chondroitin are biologically active molecules that are substrates for proteoglycan, an essential component of the cartilage matrix. Evidence supports the use of glucosamine and chondroitin as symptomatic slow-acting drugs for osteoarthritis (SYSADOAs) with impact on OA symptoms and disease-modifying effects in the long term. Glucosamine and chondroitin are administered in exogenous form as a sulfate salt and multiple formulations of these agents are available, both as prescription-grade products and nutritional supplements. However, while all preparations may claim to deliver a therapeutic level of glucosamine or chondroitin not all are supported by clinical evidence. Only patented crystalline glucosamine sulfate (pCGS) is shown to deliver consistently high glucosamine bioavailability and plasma concentration in humans, which corresponds to demonstrated clinical efficacy. Similarly, clinical evidence supports only the pharmaceutical-grade chondroitin sulfate. The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) advocates, through careful consideration of the evidence base, that judicious choice of glucosamine and chondroitin formulation is essential to maximize clinical benefit, patient adherence and satisfaction with treatment. In future, the ESCEO recommends that complex molecules with biological activity such as pCGS may be treated as "biosimilars" akin to the European Medicines Agency guidance on biological medicinal products. It seems likely that for all other complex molecules classed as SYSADOAs, the recommendation to use only formulations clearly supported by the evidence-base should apply.

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  • Authors+Show Affiliations

    ,

    Department of Public Health, Epidemiology and Health Economics, University of Liège, CHU Sart Tilman B23, 4000, Liège, Belgium. WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium.

    ,

    MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK. NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK. WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium.

    ,

    Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia. WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium.

    ,

    NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK.

    ,

    Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium.

    Department of Public Health, Epidemiology and Health Economics, University of Liège, CHU Sart Tilman B23, 4000, Liège, Belgium. jyreginster@ulg.ac.be. WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium. jyreginster@ulg.ac.be.

    Source

    MeSH

    Analgesics
    Chondroitin Sulfates
    Dietary Supplements
    Drug Therapy, Combination
    Europe
    Glucosamine
    Humans
    Osteoarthritis
    Osteoporosis
    Societies, Medical

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    29177637

    Citation

    Bruyère, Olivier, et al. "Inappropriate Claims From Non-equivalent Medications in Osteoarthritis: a Position Paper Endorsed By the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO)." Aging Clinical and Experimental Research, vol. 30, no. 2, 2018, pp. 111-117.
    Bruyère O, Cooper C, Al-Daghri NM, et al. Inappropriate claims from non-equivalent medications in osteoarthritis: a position paper endorsed by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Aging Clin Exp Res. 2018;30(2):111-117.
    Bruyère, O., Cooper, C., Al-Daghri, N. M., Dennison, E. M., Rizzoli, R., & Reginster, J. Y. (2018). Inappropriate claims from non-equivalent medications in osteoarthritis: a position paper endorsed by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Aging Clinical and Experimental Research, 30(2), pp. 111-117. doi:10.1007/s40520-017-0861-1.
    Bruyère O, et al. Inappropriate Claims From Non-equivalent Medications in Osteoarthritis: a Position Paper Endorsed By the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Aging Clin Exp Res. 2018;30(2):111-117. PubMed PMID: 29177637.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Inappropriate claims from non-equivalent medications in osteoarthritis: a position paper endorsed by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). AU - Bruyère,Olivier, AU - Cooper,Cyrus, AU - Al-Daghri,Nasser M, AU - Dennison,Elaine M, AU - Rizzoli,René, AU - Reginster,Jean-Yves, Y1 - 2017/11/24/ PY - 2017/10/11/received PY - 2017/11/11/accepted PY - 2017/11/28/pubmed PY - 2018/7/6/medline PY - 2017/11/28/entrez KW - Chondroitin sulfate KW - Glucosamine KW - Knee KW - Osteoarthritis KW - Symptomatic slow-acting drugs for osteoarthritis SP - 111 EP - 117 JF - Aging clinical and experimental research JO - Aging Clin Exp Res VL - 30 IS - 2 N2 - Osteoarthritis (OA) is a progressive joint disease, that occurs frequently in the aging population and is a major cause of disability worldwide. Both glucosamine and chondroitin are biologically active molecules that are substrates for proteoglycan, an essential component of the cartilage matrix. Evidence supports the use of glucosamine and chondroitin as symptomatic slow-acting drugs for osteoarthritis (SYSADOAs) with impact on OA symptoms and disease-modifying effects in the long term. Glucosamine and chondroitin are administered in exogenous form as a sulfate salt and multiple formulations of these agents are available, both as prescription-grade products and nutritional supplements. However, while all preparations may claim to deliver a therapeutic level of glucosamine or chondroitin not all are supported by clinical evidence. Only patented crystalline glucosamine sulfate (pCGS) is shown to deliver consistently high glucosamine bioavailability and plasma concentration in humans, which corresponds to demonstrated clinical efficacy. Similarly, clinical evidence supports only the pharmaceutical-grade chondroitin sulfate. The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) advocates, through careful consideration of the evidence base, that judicious choice of glucosamine and chondroitin formulation is essential to maximize clinical benefit, patient adherence and satisfaction with treatment. In future, the ESCEO recommends that complex molecules with biological activity such as pCGS may be treated as "biosimilars" akin to the European Medicines Agency guidance on biological medicinal products. It seems likely that for all other complex molecules classed as SYSADOAs, the recommendation to use only formulations clearly supported by the evidence-base should apply. SN - 1720-8319 UR - https://www.unboundmedicine.com/medline/citation/29177637/Inappropriate_claims_from_non_equivalent_medications_in_osteoarthritis:_a_position_paper_endorsed_by_the_European_Society_for_Clinical_and_Economic_Aspects_of_Osteoporosis_Osteoarthritis_and_Musculoskeletal_Diseases__ESCEO__ L2 - https://dx.doi.org/10.1007/s40520-017-0861-1 DB - PRIME DP - Unbound Medicine ER -