目的:本研究旨在评估两种口服对症慢作用药物治疗骨关节炎(SYSADOAs)的疗效和安全性-硫酸氨基葡萄糖,硫酸软骨素,以及他们在膝骨关节炎(KOA)治疗中的联合方案。
方法:本系统综述是根据PRISMA2020指南进行的。从1994年3月到2022年12月31日,使用包括PubMed在内的各种电子数据库进行了详细的文献检索,Embase,科克伦图书馆,和谷歌学者,使用搜索词-硫酸氨基葡萄糖(GS),硫酸软骨素(CS),膝骨关节炎,关节痛,关节疾病,和关节结构,有关氨基葡萄糖的文献,软骨素,以及它们在膝骨关节炎治疗中的组合。CochraneCollaboration的风险评估工具(5.4.1版)用于评估偏倚风险和文献质量。从纳入的研究中提取数据,并进行统计分析,以确定硫酸氨基葡萄糖的有益作用,硫酸软骨素,和他们的组合。
结果:本系统综述包括25项随机对照试验(RCT)。总之,专门为GS提供9个RCT,13个CS的RCT,和3个RCT的GS和CS的组合。所有这些研究都将其治疗组与安慰剂组进行比较。在荟萃分析中,CS显示疼痛强度显著降低,与安慰剂相比,身体功能得到改善;GS显示胫股关节间隙狭窄显着减少。虽然GS和CS的组合没有显示疼痛强度的降低,身体机能也没有任何改善。然而,组合表现出关节空间变窄的非显著减少。在安全评价中,CS和GS均显示出良好的安全性,且耐受性良好.
结论:这项荟萃分析显示,CS(疼痛强度降低,身体功能改善),和GS(关节间隙变窄显著减少)具有显著的治疗益处。然而,他们的组合并没有显着改善症状或改变疾病。这可能是由于对硫酸盐形式的干预措施的组合可用的有限试验。因此,有开展多中心随机对照试验的余地,以评估和总结CS和GS组合在KOA管理中的治疗作用.
OBJECTIVE: This study was aimed to assess the efficacy and safety of two oral Symptomatic Slow Acting Drugs for Osteoarthritis (SYSADOAs)-Glucosamine Sulfate, Chondroitin Sulfate, and their combination regimen in the management of knee osteoarthritis (KOA).
METHODS: This systematic
review was conducted according to PRISMA 2020 guidelines. A detailed literature search was performed from 03/1994 to 31/12/2022 using various electronic databases including PubMed, Embase, Cochrane Library, and Google Scholar, using the search terms-Glucosamine sulfate (GS), Chondroitin sulfate (CS), Knee osteoarthritis, Joint pain, Joint disease, and Joint structure, for literature concerning glucosamine, chondroitin, and their combination in knee osteoarthritis treatment. Cochrane Collaboration\'s Risk assessment tool (version 5.4.1) was used for assessing the risk of bias and the quality of the literature. The data was extracted from the included studies and subjected to statistical analysis to determine the beneficial effect of Glucosamine Sulfate, Chondroitin Sulfate, and their combination.
RESULTS: Twenty-five randomized controlled trials (RCTs) were included in this systematic
review. In short, exclusively 9 RCTs for GS, 13 RCTs for CS, and 3 RCTs for the combination of GS and CS. All these studies had their treatment groups compared with placebo. In the meta-analysis, CS showed a significant reduction in pain intensity, and improved physical function compared to the placebo; GS showed a significant reduction in tibiofemoral joint space narrowing. While the combination of GS and CS showed neither a reduction in pain intensity, nor any improvement in the physical function. However, the combination exhibited a non-significant reduction in joint space narrowing. In the safety evaluation, both CS and GS have shown good safety profile and were well tolerated.
CONCLUSIONS: This meta-analysis revealed that the CS (with decreased pain intensity and improvement in the physical function), and GS (with significant reduction in the joint space narrowing) have significant therapeutic benefits. However, their combination did not significantly improve the symptoms or modify the disease. This may be due to the limited trials that are available on the combination of the sulfate forms of the intervention. Hence, there is a scope for conducting multicentric randomised controlled trials to evaluate and conclude the therapeutic role of CS and GS combination in the management of KOA.