1、pOsteoarthritis of hip and knee is increasingpnon-steroidal anti-inflammatory drugs was used as the pain killerpNSAIs cause serious gastrointestinal and cardiovascular adverse events,especially with long term usepGlucosamine was used to be thought as disease modifying agents and recommended for year
2、spGlobal sales：$2bn(1.3bn,0.8bn)in 2008,60%compared with 2003,2013 reaching$2.3bnpResults from randomized trials about the effectiveness of chondroitin and glucosamine are conflictingArticle#12010.BMJImpactor 20.75Article#1pAim:To determine the effect of glucosamine,chondroitin,or the two in combina
3、tion on joint pain and on radiological progression of disease in osteoarthritis of the hip or kneepDesign:network meta-analysispOutcomes:pain release,change in minimal width of joint space pEligibility criteria:Large scale randomized controlled trials in more than 200 patients with osteoarthritis of
4、 the knee or hip that compared glucosamine,chondroitin,or their combination with placebo or head to headpGeneral character:10 trials in 3803 patients were included.Method pStatistical analysis:multivariable Bayesian hierarchical random effects modelspSignificant difference:we back transformed effect
5、 sizes to differences on a 10 cm visual analogue scale on the basis of a median pooled SD of 2.5 cm found in large scale osteoarthritis trials that assessed pain on a 10 cm visual analogue scale.pWe prespecified a minimal clinically important difference of 0.37 SD units,corresponding to 0.9 cm on a
6、10 cm visual analogue scale.pjoint space clinically important difference:SD of 1.2 mm Result Result Result Result ptests for interaction were all negative(P0.20 for interaction)Result pJoint space:pThe difference was-0.2 mm(-0.3 to 0.0 mm)in glucosaminep-0.1 mm(-0.3 to 0.1 mm)in favour of chondroiti
7、n p0.0 mm(-0.2 to 0.2 mm)for the combinationConclusion pWe believe it unlikely that future trials will show a clinically relevant benefit of any of the evaluated preparations pOur findings indicate that glucosamine,chondroitin,and their combination do not result in a relevant reduction of joint pain
8、 nor affect joint space narrowing compared with placebo.pSome patients,however,are convinced that these preparations are beneficial,which might be because of the natural course of osteoarthritis,regression to the mean,or the placebo effectLimitationspMeta-analysispheterogeneity between trials needed
9、 to be consideredpinconsistency between direct and indirect comparisonswas also need to be consideredArticle#22017.ARD(Ann Rheum Dis):12.811 Level of Evidence Level IRetrospective study Article#2pAim:to evaluate the effectiveness of oral glucosamine in subgroups of people with hip or knee osteoarthr
10、itis(OA)using individual patient data pDesign:retrospective study with individual patient data(IPD)pOutcomes:pain and function Result Result Result NSAIs cause serious gastrointestinal and cardiovascular adverse events,especially with long term useWe prespecified a minimal clinically important diffe
11、rence of 0.Thanks for your attention！20 for interaction)Blue fgures represent high pain(WOMAC pain 70),high BMI(27 kg/m2),female sex,K&L grades 34 and presence of inflammation subgroups,respectively.Significant difference:we back transformed effect sizes to differences on a 10 cm visual analogue sca
12、le on the basis of a median pooled SD of 2.General character:10 trials in 3803 patients were included.The difference was-0.Design:retrospective study with individual patient data(IPD)tests for interaction were all negative(P0.tests for interaction were all negative(P0.Statistical analysis:multivaria
13、ble Bayesian hierarchical random effects modelstests for interaction were all negative(P0.Aim:to evaluate the effectiveness of oral glucosamine in subgroups of people with hip or knee osteoarthritis(OA)using individual patient dataSome patients,however,are convinced that these preparations are benef
14、icial,which might be because of the natural course of osteoarthritis,regression to the mean,or the placebo effectRed figures represent low pain(WOMAC pain 70),low BMI(27 kg/m2),male sex,K&L grades 02 and absence of inflammation subgroups,respectively.Glucosamine does not result in a relevant reducti
15、on of joint pain and function，nor affect joint space narrowing compared with placebo.The study did not identify a subgroup for which glucosamine showed any significant beneficial effects over placebo for pain or function in either the short term or long term.Stratification only for participants with
16、 knee OA or for type of glucosamine did not result in any differences in outcomes.Thanks for your attention！Result Result Result Result p Red figures represent low pain(WOMAC pain 70),low BMI(27 kg/m2),male sex,K&L grades 02 and absence of inflammation subgroups,respectively.pBlue fgures represent h
17、igh pain(WOMAC pain 70),high BMI(27 kg/m2),female sex,K&L grades 34 and presence of inflammation subgroups,respectively.BMI,body massResult pNo statistical significance main effects were found for glucosamine over placebo pNone of the interaction terms of the predefined subgroupsreached statistical
18、significance Conclusion pThe study did not identify a subgroup for which glucosamine showed any significant beneficial effects over placebo for pain or function in either the short term or long term.pStratification only for participants with knee OA or for type of glucosamine did not result in any d
19、ifferences in outcomes.pTherefore,currently,there is no evidence to support the use of glucosamine for treatment of hip or knee OA in general and an absence of evidence to support the use of glucosamine for clinically relevant subgroups of OA according to baseline pain severity,BMI,sex,structural ab
20、normalities and presence of inflammation Take home messagepGlucosamine does not result in a relevant reduction of joint pain and function，nor affect joint space narrowing compared with placebo.pSome patients,however,are convinced that these preparations are beneficial,which might be because of the n
21、atural course of osteoarthritis,or the placebo effectArticle#12010.BMJImpactor 20.75Result Design:retrospective study with individual patient data(IPD)Outcomes:pain and functionStratification only for participants with knee OA or for type of glucosamine did not result in any differences in outcomes.
22、NSAIs cause serious gastrointestinal and cardiovascular adverse events,especially with long term useOur findings indicate that glucosamine,chondroitin,and their combination do not result in a relevant reduction of joint pain nor affect joint space narrowing compared with placebo.Blue fgures represen
23、t high pain(WOMAC pain 70),high BMI(27 kg/m2),female sex,K&L grades 34 and presence of inflammation subgroups,respectively.ConclusionDesign:retrospective study with individual patient data(IPD)We prespecified a minimal clinically important difference of 0.Aim:to evaluate the effectiveness of oral gl
24、ucosamine in subgroups of people with hip or knee osteoarthritis(OA)using individual patient dataheterogeneity between trials needed to be consideredThe difference was-0.Stratification only for participants with knee OA or for type of glucosamine did not result in any differences in outcomes.Impacto
25、r 20.NSAIs cause serious gastrointestinal and cardiovascular adverse events,especially with long term useLimitationsjoint space clinically important difference:SD of 1.Therefore,currently,there is no evidence to support the use of glucosamine for treatment of hip or knee OA in general and an absence
26、 of evidence to support the use of glucosamine for clinically relevant subgroups of OA according to baseline pain severity,BMI,sex,structural abnormalities and presence of inflammationThe study did not identify a subgroup for which glucosamine showed any significant beneficial effects over placebo f
27、or pain or function in either the short term or long term.1 mm)in favour of chondroitinResult Result Conclusion pThe study did not identify a subgroup for which glucosamine showed any significant beneficial effects over placebo for pain or function in either the short term or long term.pStratificati
28、on only for participants with knee OA or for type of glucosamine did not result in any differences in outcomes.pTherefore,currently,there is no evidence to support the use of glucosamine for treatment of hip or knee OA in general and an absence of evidence to support the use of glucosamine for clini
29、cally relevant subgroups of OA according to baseline pain severity,BMI,sex,structural abnormalities and presence of inflammation The difference was-0.The difference was-0.Some patients,however,are convinced that these preparations are beneficial,which might be because of the natural course of osteoa
30、rthritis,or the placebo effectThe difference was-0.LimitationsLimitationsThe difference was-0.Results from randomized trials about the effectiveness of chondroitin and glucosamine are conflictingBMI,body massAim:to evaluate the effectiveness of oral glucosamine in subgroups of people with hip or kne
31、e osteoarthritis(OA)using individual patient dataWe prespecified a minimal clinically important difference of 0.Design:retrospective study with individual patient data(IPD)Limitationsheterogeneity between trials needed to be consideredGlucosamine was used to be thought as disease modifying agents an
32、d recommended for yearsImpactor 20.Impactor 20.ConclusionBlue fgures represent high pain(WOMAC pain 70),high BMI(27 kg/m2),female sex,K&L grades 34 and presence of inflammation subgroups,respectively.General character:10 trials in 3803 patients were included.NSAIs cause serious gastrointestinal and
33、cardiovascular adverse events,especially with long term usenon-steroidal anti-inflammatory drugs was used as the pain killer20 for interaction)Glucosamine does not result in a relevant reduction of joint pain and function，nor affect joint space narrowing compared with placebo.Impactor 20.Therefore,c
34、urrently,there is no evidence to support the use of glucosamine for treatment of hip or knee OA in general and an absence of evidence to support the use of glucosamine for clinically relevant subgroups of OA according to baseline pain severity,BMI,sex,structural abnormalities and presence of inflamm
35、ation20 for interaction)Design:retrospective study with individual patient data(IPD)Glucosamine does not result in a relevant reduction of joint pain and function，nor affect joint space narrowing compared with placebo.The difference was-0.Global sales：$2bn(1.Limitationstests for interaction were all
36、 negative(P0.Thanks for your attention！The study did not identify a subgroup for which glucosamine showed any significant beneficial effects over placebo for pain or function in either the short term or long term.Glucosamine does not result in a relevant reduction of joint pain and function，nor affe
37、ct joint space narrowing compared with placebo.Therefore,currently,there is no evidence to support the use of glucosamine for treatment of hip or knee OA in general and an absence of evidence to support the use of glucosamine for clinically relevant subgroups of OA according to baseline pain severit
38、y,BMI,sex,structural abnormalities and presence of inflammationMeta-analysisThanks for your attention！Blue fgures represent high pain(WOMAC pain 70),high BMI(27 kg/m2),female sex,K&L grades 34 and presence of inflammation subgroups,respectively.Thanks for your attention！heterogeneity between trials
39、needed to be considered1 mm)in favour of chondroitinnon-steroidal anti-inflammatory drugs was used as the pain killerTherefore,currently,there is no evidence to support the use of glucosamine for treatment of hip or knee OA in general and an absence of evidence to support the use of glucosamine for
40、clinically relevant subgroups of OA according to baseline pain severity,BMI,sex,structural abnormalities and presence of inflammationheterogeneity between trials needed to be consideredBlue fgures represent high pain(WOMAC pain 70),high BMI(27 kg/m2),female sex,K&L grades 34 and presence of inflamma
41、tion subgroups,respectively.The difference was-0.Some patients,however,are convinced that these preparations are beneficial,which might be because of the natural course of osteoarthritis,or the placebo effectRed figures represent low pain(WOMAC pain 70),low BMI(27 kg/m2),male sex,K&L grades 02 and a
42、bsence of inflammation subgroups,respectively.The difference was-0.The difference was-0.Outcomes:pain release,change in minimal width of joint spaceWe prespecified a minimal clinically important difference of 0.37 SD units,corresponding to 0.1 mm)in favour of chondroitinSignificant difference:we bac
43、k transformed effect sizes to differences on a 10 cm visual analogue scale on the basis of a median pooled SD of 2.Aim:to evaluate the effectiveness of oral glucosamine in subgroups of people with hip or knee osteoarthritis(OA)using individual patient dataMeta-analysisNo statistical significance mai
44、n effects were found for glucosamine over placeboARD(Ann Rheum Dis):12.Statistical analysis:multivariable Bayesian hierarchical random effects modelsThe study did not identify a subgroup for which glucosamine showed any significant beneficial effects over placebo for pain or function in either the s
45、hort term or long term.The difference was-0.Global sales：$2bn(1.Design:retrospective study with individual patient data(IPD)Aim:to evaluate the effectiveness of oral glucosamine in subgroups of people with hip or knee osteoarthritis(OA)using individual patient data37 SD units,corresponding to 0.37 S
46、D units,corresponding to 0.Glucosamine was used to be thought as disease modifying agents and recommended for yearsDesign:retrospective study with individual patient data(IPD)Some patients,however,are convinced that these preparations are beneficial,which might be because of the natural course of os
47、teoarthritis,regression to the mean,or the placebo effectThanks for your attention！Thanks for your attention！We prespecified a minimal clinically important difference of 0.Aim:to evaluate the effectiveness of oral glucosamine in subgroups of people with hip or knee osteoarthritis(OA)using individual
48、 patient dataThe difference was-0.The study did not identify a subgroup for which glucosamine showed any significant beneficial effects over placebo for pain or function in either the short term or long term.Therefore,currently,there is no evidence to support the use of glucosamine for treatment of hip or knee OA in general and an absence of evidence to support the use of glucosamine for clinically relevant subgroups of OA according to baseline pain severity,BMI,sex,structural abnormalities and presence of inflammationWe prespecified a minimal clinically important difference of 0.
