Хондропротекторы

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Müller and colleagues19 evaluated the short-term 4-week effects of 1,200 mg of GS using Lequesne's severity index and looked at the relative risks of side effects in the GS group versus the ibuprofen group. In this short 1-month study, GS was as effective as ibuprofen and significantly better tolerated (P < .001). Only 6% of patients taking GS reported adverse events, whereas 35% of ibuprofen users had an adverse event (mainly gastrointestinal in origin).
Noack et al.20 published a 4-week study comparing GS with placebo rather than ibuprofen. This short study of 252 patients showed that GS was more effective than placebo in improving OA symptomatology. Patients in the GS arm of the trial enjoyed a 3.3-point drop in Lequesne's severity index, whereas those taking the placebo improved by 2.0 points. A 6-week study by Reichelt et al.21 showed GS to decrease Lequesne's index over placebo in 155 patients. Unfortunately, these studies are too short to make significant long-term conclusions.
In 2001 Reginster et al.22 published the results of a trial in which 212 patients were randomized to receive placebo or GS daily for 3 years. Glucosamine was shown to protect the joint space from the narrowing effects of OA. A trend toward improving Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores was seen without any statistically significant change.
A similar study by Pavelká et al.23 supported the findings of Reginster et al.,22 proving statistically significant effects of glucosamine on both radiographic progression and WOMAC scores.
Bruyere et al.24 used the same outcome measures of joint space narrowing and WOMAC scores to prove that the disease-modifying effects seen in the study of Pavelká et al.23 were also found in the older postmenopausal female population. Bruyere et al.25 investigated joint space narrowing in 212 knee OA patients at 3 years. Patients with less severe radiographic knee OA had the most dramatic disease progression as seen by joint space narrowing. The GS group, compared with the placebo group, showed a nonstatistical trend in significant reduction of joint space narrowing.
Cibere et al.26 tested GS in a 4-center 6-month randomized, double-blind, placebo-controlled study. No differences were found in the severity of disease pain episodes (flare-ups) or other secondary outcomes between placebo- and glucosamine-treated patients. They concluded that there was no evidence of symptomatic benefits from continued GS use from this 6-month study.
Herrero-Beaumont et al.27 evaluated 318 patients with knee OA in an RCT comparing GS, acetaminophen (Tylenol; McNeil Consumer Healthcare, a division of Johnson & Johnson, Guelph, Ontario, Canada), and placebo. After 6 months, 1,500 mg of GS was found to be better than placebo and acetaminophen by use of Lequesne's index and the WOMAC.
Hughes and Carr28 performed a randomized clinical trial with GS in 80 OA patients for 24 weeks. They found a 33% placebo response rate and no statistical improvement over placebo as a symptom modifier.
Collectively, these GS studies showed that GS as an individual agent may have some effect on the progression of the disease and was as safe as placebo at a dose of 1,200 to 1,500 mg/d for up to 3 years. Many studies had a short-term follow-up, and the evidence inconsistently supported the use of glucosamine as an effective alternative to higher-risk medications such as NSAIDs and cyclooxygenase II inhibitors for knee OA