Talk:Clinical trials on glucosamine and chondroitin

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Creation of this page[edit]

This article, currently titled Clinical trials on glucosamine and chondroitin, was created by cutting and pasting information from the articles on Chondroitin sulfate and glucosamine.

The information in this article about the clinical research is WP:UNDUE for inclusion into those articles per WP:MEDMOS, the medical manual of style, which says that articles about treatments should include certain information and exclude other information. The amount of information which is merited in those articles is the best available consensus statements about the outcomes of many years of the research. Until this article was created, those articles contained a history of the treatment research covering the use of glucosamine and chondroitin.

Further complicating the matter is that the information in this article is replicated in the articles on glucosamine, chondroitin, and osteoarthritis. This page should have all the information about the trials, and those pages should omit that information and instead link to this page as a centralized resource.

I would like to also note that Wikipedia does not have good policies or precedent on deciding what to do with records of clinical research. In articles like German acupuncture trials, there has been much debate about the extent to which Wikipedia should report disputed health recommendations which at some times and in some places have been covered in reliable sources and seem to meet general criteria for inclusion into Wikipedia. While I am creating this article, I am not evaluating, supporting, or dismissing any of the content in it. The only reason I am moving it here is because at first look, it seems to be well-sourced information and because it definitely ought not be forked and independently developed in multiple articles on Wikipedia. Blue Rasberry (talk) 18:39, 20 May 2014 (UTC)[reply]

Is this article exempt from secondary source rule?[edit]

Is there something special about this article that allows it to reference primary sources instead of being restricted to refer to secondary sourced, i.e. reviews? — Preceding unsigned comment added by Sthubbar (talk • contribs) 00:59, 28 May 2014 (UTC)[reply]

Primary & tertiary sources are allowed, though in most case secondary sources are preferred. WP:PSTS is one place that explains this, you could also look at {{Wikipedia_policies_and_guidelines}}. I agree that this article would be helped by mainly using secondary sources. Lentower (talk) 22:10, 28 May 2014 (UTC)[reply]
No. I just cut and pasted this content from the glucosamine and chondroitin articles because it definitely did not belong there but I did not have time to review it to see if it should remain at all. I suspect that much of it could be deleted. Anyone who checks this content should feel free to delete what does not comply with all usual guidelines. Blue Rasberry (talk) 00:13, 29 May 2014 (UTC)[reply]
Even the meta-analyses are not in agreement. At least two problems - 1) the number of trials authors chose to include, based on differences in inclusion/exclusion criteria, vary widely across the meta-analyses, and 2) the large size of the negative-findings GAIT trial pulls the collective results down. A partial list of meta-analyses
  1. Singh JA. Chondroitin for osteoarthritis. Cochrane Database Syst Rev 2015 Jan 28;1:CD005614.
  2. Hochberg M. Symptom and structure modification in osteoarthritis with pharmaceutical-grade chondroitin sulfate: what's the evidence? Curr Med Res Opin 2013;29(3):259-267.
  3. Wandel S. Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis. BMJ 2010;341:c4675.
  4. Hochberg MC. Structure-modifying effects of chondroitin sulfate in knee osteoarthritis: an updated meta-analysis of randomized placebo-controlled trials of 2-year duration. Osteoarthritis Cartilage 2010;18(Suppl):S28-S31.
  5. Lee YH. Effect of glucosamine or chondroitin sulfate on the osteoarthritis progression: a meta-analysis. Rheumatol Int 2010;30(3):357-363.
  6. Hochberg. The rate of decline of joint space width in patients with osteoarthritis of the knee: a systematic review and meta-analysis of randomized placebo-controlled trials of chondroitin sulfate. Curr Med Res Opin 2008;24(11):3029-35.
  7. Reichenbach. Meta-analysis: chondroitin for osteoarthritis of the knee or hip. Ann Intern Med 2007;146(8):580-590.
  8. McAlindon TE. Glucosamine and chondroitin treatment of osteoarthritis. JAMA 2000;283:1469-75.
  9. Richy F. Structural and symptomatic efficacy of glucosamine and chondroitin in knee osteoarthritis: a comprehensive meta-analysis. Arch Intern Med 2003;163:1514-22.
  10. Leeb BF. A meta-analysis of chondroitin sulfate on the treatment of osteoarthritis. J Rheumatol 2000;27:205-211.
David notMD (talk) 13:01, 31 March 2017 (UTC)[reply]
David notMD Yes, I also see what you see. Various review articles say different things. I am not sure what to do about it. Blue Rasberry (talk) 14:20, 31 March 2017 (UTC)[reply]
I am not either, hence my posting the meta-analyses here. The problem is compounded by fact that great majority of trials were relatively short (1-3 months) and focused on pain relief and quality of life. There is a strong placebo effect - on order of 40% - but in some trials exceeding 60%. This reduces opportunity to reach statistical significance. A small subset of trials were 1-3 years duration and looked for changes in the rate of loss of cartilage in the knee joint. Even when those had interesting results, did not include any other body location for osteoarthritis. David notMD (talk) 09:08, 1 April 2017 (UTC)[reply]

Sulfate != HCL[edit]

This was mentioned quite a bit on the Osteoarthritis talk page and completely ignored here. There is significant evidence that the Sulfate and HCL preparations of glucosamine are different with sulfate showing effect and HCL not. It is completely possible that sulfate by itself is the active agent, and there are no studies that compare glucosamine sulfate to sulfate by itself. This would clearly explain the conflicting evidence and invalidate any meta-analysis or review that ignores this different. It would be the same as doing a meta-analysis of CO2 and CO and saying that there is conflicting evidence.

In my opinion this article needs a complete rewrite highlighting this, especially in light of the most recent Long-term Evaluation of Glucosamine Sulfate results.Sthubbar (talk) 01:03, 28 May 2014 (UTC)[reply]

Here on Wikipedia, we create and edit content based on sources, especially secondary sources. If you can find sufficient sources that support the points you make here, use them to rewrite the article. Lentower (talk) 22:14, 28 May 2014 (UTC)[reply]

"no unequivocal evidence" is completely unsupported by reference[edit]

These statements

"Its use as a therapy for osteoarthritis appears safe,[citation needed] but there is no unequivocal evidence for its effectiveness. There have been multiple clinical trials testing glucosamine as a potential medical therapy for osteoarthritis with conflicting results. The evidence regarding the efficacy of either sulfate or HCL preparations is conflicting."

is completely unreferenced and could just as easily say "there is no unequivocal evidence showing it is equal to placebo" or "there is no unequivocal evidence showing it is harmful". unlike what it has been replaced with, a balanced presentation with each statement having multiple references.

"The effectiveness of glucosamine is controversial.[1][2] Most recent reviews found it to be equal to[3][4] or only slight better than placebo.[5][6] A difference may exist between glucosamine sulfate and glucosamine hydrochloride, with glucosamine sulfate showing a benefit and glucosamine hydrochloride not.[7] The Osteoarthritis Research Society International recommends that glucosamine be discontinued if no effect is observed after six months[8] and the National Institute of Clinical Excellence no longer recommends its use.[9] Despite the difficulty in determining the efficacy of glucosamine, it remains a viable treatment option.[10]"
  1. ^ The effects of Glucosamine Sulphate on OA of the knee joint. BestBets.
  2. ^ Burdett, N (2012 Sep). "Difficulties with assessing the benefit of glucosamine sulphate as a treatment for osteoarthritis". International journal of evidence-based healthcare. 10 (3): 222–6. PMID 22925619. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  3. ^ Wandel, S (2010 Sep 16). "Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis". BMJ (Clinical research ed.). 341: c4675. PMID 20847017. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  4. ^ Wu, D (2013 Jun). "Efficacies of different preparations of glucosamine for the treatment of osteoarthritis: a meta-analysis of randomised, double-blind, placebo-controlled trials". International journal of clinical practice. 67 (6): 585–94. PMID 23679910. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  5. ^ Chou, R (2011 Oct). PMID 22091473. {{cite journal}}: Check date values in: |date= (help); Cite journal requires |journal= (help); Missing or empty |title= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  6. ^ Miller KL, Clegg DO (2011). "Glucosamine and chondroitin sulfate". Rheum. Dis. Clin. North Am. 37 (1): 103–18. doi:10.1016/j.rdc.2010.11.007. PMID 21220090. The best current evidence suggests that the effect of these supplements, alone or in combination, on OA pain, function, and radiographic change is marginal at best. {{cite journal}}: Unknown parameter |month= ignored (help)
  7. ^ Rovati, LC (2012 Jun). "Crystalline glucosamine sulfate in the management of knee osteoarthritis: efficacy, safety, and pharmacokinetic properties". Therapeutic advances in musculoskeletal disease. 4 (3): 167–80. PMID 22850875. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  8. ^ Zhang W; Moskowitz RW; Nuki G; et al. (2008). "OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines" (PDF). Osteoarthr. Cartil. 16 (2): 137–62. doi:10.1016/j.joca.2007.12.013. PMID 18279766. {{cite journal}}: Unknown parameter |author-separator= ignored (help); Unknown parameter |month= ignored (help)
  9. ^ Cite error: The named reference NICE was invoked but never defined (see the help page).
  10. ^ Henrotin, Y (2012 Jan 30). "Is there any scientific evidence for the use of glucosamine in the management of human osteoarthritis?". Arthritis Research & Therapy. 14 (1): 201. PMID 22293240. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)

— Preceding unsigned comment added by Sthubbar (talk • contribs) 03:11, 12 July 2014‎

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