氨糖在骨關(guān)節(jié)炎中的應(yīng)用課件

1、Osteoarthritis of hip and knee is increasingnon-steroidal anti-inflammatory drugs was used as the pain killerNSAIs cause serious gastrointestinal and cardiovascular adverse events, especially with long term useGlucosamine was used to be thought as disease modifying agents and recommended for yearsGl

2、obal sales：$2bn (1.3bn, 0.8bn) in 2008, 60% compared with 2003, 2013 reaching $2.3bnResults from randomized trials about the effectiveness of chondroitin and glucosamine are conflictingIntroductionOsteoarthritis of hip and kneeArticle #12010 . BMJImpactor 20.75Article #12010 . BMJArticle #1Aim: To d

3、etermine the effect of glucosamine, chondroitin, or the two in combination on joint pain and on radiological progression of disease in osteoarthritis of the hip or kneeDesign: network meta-analysisOutcomes: pain release, change in minimal width of joint space Eligibility criteria: Large scale random

4、ized controlled trials in more than 200 patients with osteoarthritis of the knee or hip that compared glucosamine, chondroitin, or their combination with placebo or head to headGeneral character: 10 trials in 3803 patients were included. Article #1Aim: To determine thMethod Statistical analysis: mul

5、tivariable Bayesian hierarchical random effects modelsSignificant difference: we back transformed effect 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.W

6、e prespecified a minimal clinically important difference of 0.37 SD units, corresponding to 0.9 cm on a 10 cm visual analogue scale. joint space clinically important difference : SD of 1.2 mm Method Statistical analysis: mResult Result Result Result Result Result Result tests for interaction were al

7、l negative (P0.20 for interaction) Result tests for interaction wResult Joint space: The difference was -0.2 mm (-0.3 to 0.0 mm) in glucosamine-0.1 mm (-0.3 to 0.1 mm) in favour of chondroitin 0.0 mm (-0.2 to 0.2 mm) for the combinationResult Joint space: Conclusion We believe it unlikely that futur

8、e trials will show a clinically relevant benefit of any of the evaluated preparations Our 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. Some patients, however, are con

9、vinced that these preparations are beneficial, which might be because of the natural course of osteoarthritis, regression to the mean, or the placebo effectConclusion We believe it unlikLimitationsMeta-analysisheterogeneity between trials needed to be consideredinconsistency between direct and indir

10、ect comparisonswas also need to be consideredLimitationsMeta-analysisArticle #22017 . ARD (Ann Rheum Dis ): 12.811Level of Evidence Level IRetrospective study Article #22017 . ARD (Ann RheuArticle #2Aim: to evaluate the effectiveness of oral glucosamine in subgroups of people with hip or knee osteoa

11、rthritis (OA) using individual patient data Design: retrospective study with individual patient data (IPD)Outcomes: pain and function Article #2Aim: to evaluate theResult Result Result Result Result Result NSAIs cause serious gastrointestinal and cardiovascular adverse events, especially with long t

12、erm useWe prespecified a minimal clinically important difference 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 inammation subgroups, respectively.Significant difference: we back transf

13、ormed effect sizes to differences on a 10 cm visual analogue scale 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

14、 for interaction were all negative (P0.Statistical analysis: multivariable 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 patien

15、t dataSome 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 effectRed figures represent low pain (WOMAC pain 70), low BMI (27 kg/m2), male sex, K&L grades 02 and absence of

16、inammation subgroups, respectively.Glucosamine does not result in a relevant reduction 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 func

17、tion in either the short term or long term.Stratification only for participants with knee OA or for type of glucosamine did not result in any differences in outcomes.Thanks for your attention！Result NSAIs cause serious gastrointeResult Result Result Result Result Red figures represent low pain (WOMA

18、C pain 70), low BMI (27 kg/m2), male sex, K&L grades 02 and absence of inammation subgroups, respectively. Blue fgures represent high pain (WOMAC pain 70), high BMI (27 kg/m2), female sex, K&L grades 34 and presence of inammation subgroups, respectively. BMI, body massResult Red figures represent Re

19、sult No statistical significance main effects were found for glucosamine over placebo None of the interaction terms of the predefined subgroupsreached statistical significance Result No statistical significConclusion The study did not identify a subgroup for which glucosamine showed any significant

20、beneficial effects over placebo for pain or function in either the short term or long term. Stratification only for participants with knee OA or for type of glucosamine did not result in any differences in outcomes. Therefore, currently, there is no evidence to support the use of glucosamine for tre

21、atment 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 inflammation Conclusion The study did not iTake home messageGlucosamine doe

22、s not result in a relevant reduction of joint pain and function，nor affect joint space narrowing compared with placebo. Some patients, however, are convinced that these preparations are beneficial, which might be because of the natural course of osteoarthritis, or the placebo effectTake home message

23、Glucosamine dThanks for your attention！Thanks for your attention！Article #12010 . BMJImpactor 20.75Article #12010 . BMJResult Result Design: retrospective study with individual patient data (IPD)Outcomes: pain and functionStratification only for participants with knee OA or for type of glucosamine d

24、id not result in any differences in outcomes.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 narr

25、owing compared with placebo.Blue fgures represent high pain (WOMAC pain 70), high BMI (27 kg/m2), female sex, K&L grades 34 and presence of inammation subgroups, respectively.ConclusionDesign: retrospective study with individual patient data (IPD)We prespecified a minimal clinically important differ

26、ence of 0.Aim: to evaluate the effectiveness of oral glucosamine 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 glucosa

27、mine did not result in any differences in outcomes.Impactor 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 glucos

28、amine 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 inflammationThe study did not identify a subgroup for which gl

29、ucosamine showed any significant beneficial effects over placebo for pain or function in either the short term or long term.1 mm) in favour of chondroitinResult Design: retrospective study wiResult Result Conclusion The study did not identify a subgroup for which glucosamine showed any significant b

30、eneficial effects over placebo for pain or function in either the short term or long term. Stratification only for participants with knee OA or for type of glucosamine did not result in any differences in outcomes. Therefore, currently, there is no evidence to support the use of glucosamine for trea

31、tment 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 inflammation Conclusion The study did not iThe difference was -0.The differe

32、nce 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 effectThe difference was -0.LimitationsLimitationsThe difference was -0.Results from randomized trials about the effectiveness of ch

33、ondroitin and glucosamine are conflictingBMI, body massAim: to evaluate the effectiveness of oral glucosamine in subgroups of people with hip or knee osteoarthritis (OA) using individual patient dataWe prespecified a minimal clinically important difference of 0.Design: retrospective study with indiv

34、idual patient data (IPD)Limitationsheterogeneity between trials needed to be consideredGlucosamine was used to be thought as disease modifying agents and recommended for yearsImpactor 20.Impactor 20.ConclusionBlue fgures represent high pain (WOMAC pain 70), high BMI (27 kg/m2), female sex, K&L grade

35、s 34 and presence of inammation subgroups, respectively.General character: 10 trials in 3803 patients were included.NSAIs cause serious gastrointestinal and cardiovascular adverse events, especially with long term usenon-steroidal anti-inflammatory drugs was used as the pain killer20 for interaction

36、)Glucosamine does not result in a relevant reduction of joint pain and function，nor affect joint space narrowing compared with placebo.Impactor 20.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 sup

37、port the use of glucosamine for clinically relevant subgroups of OA according to baseline pain severity, BMI, sex, structural abnormalities and presence of inflammation20 for interaction)Design: retrospective study with individual patient data (IPD)Glucosamine does not result in a relevant reduction

38、 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 negative (P0.Thanks for your attention！The study did not identify a subgroup for which glucosamine showed any significant beneficial

39、 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 affect joint space narrowing compared with placebo.Therefore, currently, there is no evidence to support the use of glucosamine for trea

40、tment 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 inflammationMeta-analysisThanks for your attention！Blue fgures represent hig

41、h pain (WOMAC pain 70), high BMI (27 kg/m2), female sex, K&L grades 34 and presence of inammation subgroups, respectively.Thanks for your attention！heterogeneity between trials needed to be considered1 mm) in favour of chondroitinnon-steroidal anti-inflammatory drugs was used as the pain killerThere

42、fore, 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

43、 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 inammation subgroups, respectively.The difference was -0.Some patients, however, are convinced that these preparations a

44、re 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 absence of inammation subgroups, respectively.The difference was -0.The difference was -0.Outcomes: pain

45、 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 back transformed effect sizes to differences on a 10 cm visual analogue scale on the basis of a medi

46、an 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 main 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 short term o