Meta-analysis: chondroitin for osteoarthritis of the knee or hip

Reichenbach, Stephan; Sterchi, Rebekka; Scherer, Martin; Trelle, Sven; Bürgi, Elizabeth; Bürgi, Ulrich; Dieppe, Paul A; Jüni, Peter (2007). Meta-analysis: chondroitin for osteoarthritis of the knee or hip. Annals of internal medicine, 146(8), pp. 580-90. Philadelphia, Pa.: American College of Physicians

[img] Text
Reichenbach AnnInternMed 2007.pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (461kB) | Request a copy

BACKGROUND: Previous meta-analyses described moderate to large benefits of chondroitin in patients with osteoarthritis. However, recent large-scale trials did not find evidence of an effect. PURPOSE: To determine the effects of chondroitin on pain in patients with osteoarthritis. DATA SOURCES: The authors searched the Cochrane Central Register of Controlled Trials (1970 to 2006), MEDLINE (1966 to 2006), EMBASE (1980 to 2006), CINAHL (1970 to 2006), and conference proceedings; checked reference lists; and contacted authors. The last update of searches was performed on 30 November 2006. STUDY SELECTION: Studies were included if they were randomized or quasi-randomized, controlled trials that compared chondroitin with placebo or with no treatment in patients with osteoarthritis of the knee or hip. There were no language restrictions. DATA EXTRACTION: The authors extracted data in duplicate. Effect sizes were calculated from the differences in means of pain-related outcomes between treatment and control groups at the end of the trial, divided by the pooled SD. Trials were combined by using random-effects meta-analysis. DATA SYNTHESIS: 20 trials (3846 patients) contributed to the meta-analysis, which revealed a high degree of heterogeneity among the trials (I2 = 92%). Small trials, trials with unclear concealment of allocation, and trials that were not analyzed according to the intention-to-treat principle showed larger effects in favor of chondroitin than did the remaining trials. When the authors restricted the analysis to the 3 trials with large sample sizes and an intention-to-treat analysis, 40% of patients were included. This resulted in an effect size of -0.03 (95% CI, -0.13 to 0.07; I2 = 0%) and corresponded to a difference of 0.6 mm on a 10-cm visual analogue scale. A meta-analysis of 12 trials showed a pooled relative risk of 0.99 (CI, 0.76 to 1.31) for any adverse event. LIMITATIONS: For 9 trials, the authors had to use approximations to calculate effect sizes. Trial quality was generally low, heterogeneity among the trials made initial interpretation of results difficult, and exploring sources of heterogeneity in meta-regression and stratified analyses may be unreliable. CONCLUSIONS: Large-scale, methodologically sound trials indicate that the symptomatic benefit of chondroitin is minimal or nonexistent. Use of chondroitin in routine clinical practice should therefore be discouraged.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine

UniBE Contributor:

Reichenbach, Stephan; Sterchi, Rebekka; Trelle, Sven; Bürgi, Ulrich and Jüni, Peter

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0003-4819

ISBN:

17438317

Publisher:

American College of Physicians

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 14:53

Last Modified:

26 Jan 2015 06:56

PubMed ID:

17438317

Web of Science ID:

000245778000004

BORIS DOI:

10.7892/boris.22654

URI:

https://boris.unibe.ch/id/eprint/22654 (FactScience: 35732)

Actions (login required)

Edit item Edit item
Provide Feedback