According to an oral presentation at the European League Against Rheumatism (EULAR) congress of rheumatology in Madrid, chondroitin sulphate (CS) will receive increased attention as the need for safer alternatives to nonsteroidal anti-inflammatory drugs (NSAID) in osteoarthritis (OA) management rises.
Results of a 24-month MOSAIC study on structural changes in knee OA patients receiving CS show disease-modifying effects of CS, with reduced cartilage volume loss at 24 months following treatment. This study was assessed by quantitative magnetic resonance imaging (qMRI).
OA is a slowly progressive joint disease and a major cause of disability and pain among the elderly, second only to cardiovascular disease. The OA market is largely genericised and the lack of disease-modifying OA drugs (DMOAD) presents a significant unmet need as current standard of care centers around symptom management and is often associated with serious adverse events in the target patient population.
The MOSAIC study was a multicenter, randomised, comparative, double-blind, double-dummy, controlled exploratory study assessing the disease-modifying effect of CS in 194 KL2-KL3 OA patients with signs of synovitis and minimum joint space width of ≥2mm. Participants were randomised to either 1,200mg CS (Condrosan) daily or 200mg celecoxib. Primary outcomes assessed the effects of CS on cartilage volume loss in the knee at 24 months using qMRI. Exploratory outcomes included cartilage volume loss in the global knee and medial compartments, severity of synovitis, bone marrow lesion (BML) changes, and changes in Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC) and visual analogue scale (VAS) scores.
Results of the study showed significant changes in magnetic resonance imaging (MRI) parameters in the medial compartment of the knee in patients treated with CS as compared with celecoxib at both 12 months and 24 months (p=0.049 and p=0.021, respectively). In addition, CS-treated patients showed less cartilage loss in the medial compartment (p=0.036) at 24 months. There was evidence of reduction of synovial membrane swelling and no effect was shown on the bone marrow lesions (BML). In terms of the WOMAC and VAS scores, celecoxib achieved pain reduction faster than CS. However, the effect was similar by the 12 month for both therapies and remained as such until the end of the study, at 24 months.
In addition, complementing trial CONCEPT assessed the efficacy of pharmaceutical grade CS versus celecoxib and versus placebo in knee OA. It demonstrated that CS is as effective as celecoxib and superior to placebo, as well as having the advantage of an improved safety profile.
Although current literature on the efficacy of CS in OA treatment is inconclusive, consensus recommendations for the management of hand, hip, and knee OA by the Pan-American League of Associations of Rheumatology (PANLAR) presented on 14 June at the EULAR congress suggests good evidence for the use of CS for the treatment of hand and knee OA due to improved pain and function in these patient groups.
In conclusion, the MOSAIC study sheds a new light on this popular supplement and with new evidence on the disease-modifying effects of CS in knee OA patients, CS has the potential to provide a safer alternative to the standard of care in patients where the use of NSAIDs is contraindicated.