氨糖在骨关节炎中的应用教学课件.pptx

1、pOsteoarthritis of hip and knee is increasingpnon-steroidal anti-inflammatory drugs was used as the pain killerpNSAIs cause serious gastrointestinal and cardiovascular adverse events,especially with long term usepGlucosamine was used to be thought as disease modifying agents and recommended for year

2、spGlobal sales：$2bn(1.3bn,0.8bn)in 2008,60%compared with 2003,2013 reaching$2.3bnpResults from randomized trials about the effectiveness of chondroitin and glucosamine are conflictingArticle#12010.BMJImpactor 20.75Article#1pAim:To determine the effect of glucosamine,chondroitin,or the two in combina

3、tion on joint pain and on radiological progression of disease in osteoarthritis of the hip or kneepDesign:network meta-analysispOutcomes:pain release,change in minimal width of joint space pEligibility criteria:Large scale randomized controlled trials in more than 200 patients with osteoarthritis of

4、 the knee or hip that compared glucosamine,chondroitin,or their combination with placebo or head to headpGeneral character:10 trials in 3803 patients were included.Method pStatistical analysis:multivariable Bayesian hierarchical random effects modelspSignificant difference:we back transformed effect

5、 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.pWe prespecified a minimal clinically important difference of 0.37 SD units,corresponding to 0.9 cm on a

6、10 cm visual analogue scale.pjoint space clinically important difference:SD of 1.2 mm Result Result Result None of the interaction terms of the predefined subgroupsreached statistical significanceThe difference was-0.None of the interaction terms of the predefined subgroupsreached statistical signif

7、icanceOsteoarthritis of hip and knee is increasingRetrospective studyRetrospective study0 mm)in glucosaminejoint space clinically important difference:SD of 1.Impactor 20.Impactor 20.Therefore,currently,there is no evidence to support the use of glucosamine for treatment of hip or knee OA in general

8、 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 inflammationImpactor 20.Significant difference:we back transformed effect sizes to differences on a 10 cm visual

9、analogue scale on the basis of a median pooled SD of 2.We believe it unlikely that future trials will show a clinically relevant benefit of any of the evaluated preparationsinconsistency between direct and indirect comparisonswas also need to be consideredMeta-analysisTake home messageStratification

10、 only for participants with knee OA or for type of glucosamine did not result in any differences in outcomes.No statistical significance main effects were found for glucosamine over placeboThe study did not identify a subgroup for which glucosamine showed any significant beneficial effects over plac

11、ebo for pain or function in either the short term or long term.Result ptests for interaction were all negative(P0.20 for interaction)Result pJoint space:pThe difference was-0.2 mm(-0.3 to 0.0 mm)in glucosaminep-0.1 mm(-0.3 to 0.1 mm)in favour of chondroitin p0.0 mm(-0.2 to 0.2 mm)for the combination

12、Conclusion pWe believe it unlikely that future trials will show a clinically relevant benefit of any of the evaluated preparations pOur findings indicate that glucosamine,chondroitin,and their combination do not result in a relevant reduction of joint pain nor affect joint space narrowing compared w

13、ith placebo.pSome 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 effectLimitationspMeta-analysispheterogeneity between trials needed to be consideredpinconsistency between dire

14、ct and indirect comparisonswas also need to be consideredArticle#22017.ARD(Ann Rheum Dis):12.811 Level of Evidence Level IRetrospective study Article#2pAim:to evaluate the effectiveness of oral glucosamine in subgroups of people with hip or knee osteoarthritis(OA)using individual patient data pDesig

15、n:retrospective study with individual patient data(IPD)pOutcomes:pain and function Result Result Result Result Result Result Result p Red figures represent low pain(WOMAC pain 70),low BMI(27 kg/m2),male sex,K&L grades 02 and absence of inflammation subgroups,respectively.pBlue fgures represent high

16、pain(WOMAC pain 70),high BMI(27 kg/m2),female sex,K&L grades 34 and presence of inflammation subgroups,respectively.BMI,body massResult pNo statistical significance main effects were found for glucosamine over placebo pNone of the interaction terms of the predefined subgroupsreached statistical sign

17、ificance 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.Level of Evidence Level I37 SD units,corresponding to 0.joint space clinically important difference:SD of 1.Joi

18、nt space:inconsistency between direct and indirect comparisonswas also need to be consideredRetrospective studyStratification only for participants with knee OA or for type of glucosamine did not result in any differences in outcomes.Statistical analysis:multivariable Bayesian hierarchical random ef

19、fects modelsjoint space clinically important difference:SD of 1.9 cm on a 10 cm visual analogue scale.20 for interaction)The 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 or long term.Joint

20、 space:5 cm found in large scale osteoarthritis trials that assessed pain on a 10 cm visual analogue scale.inconsistency between direct and indirect comparisonswas also need to be consideredImpactor 20.0 mm)in glucosamineDesign:retrospective study with individual patient data(IPD)ARD(Ann Rheum Dis):

21、12.Aim:To determine 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 kneeConclusion pThe study did not identify a subgroup for which glucosamine showed any significant beneficial effects over plac

22、ebo for pain or function in either the short term or long term.pStratification only for participants with knee OA or for type of glucosamine did not result in any differences in outcomes.pTherefore,currently,there is no evidence to support the use of glucosamine for treatment of hip or knee OA in ge

23、neral 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 Take home messagepGlucosamine does not result in a relevant reduction of joint pain and functio

24、n，nor affect joint space narrowing compared with placebo.pSome patients,however,are convinced that these preparations are beneficial,which might be because of the natural course of osteoarthritis,or the placebo effectArticle#12010.BMJImpactor 20.75Result Result Result 37 SD units,corresponding to 0.

25、tests for interaction were all negative(P0.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 support the use of glucosamine for clinically relevant subgroups of OA according to baseline pain severity,BM

26、I,sex,structural abnormalities and presence of inflammationImpactor 20.joint space clinically important difference:SD of 1.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 place

27、bo.Significant 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.None of the interaction terms of the predefined subgroupsreached statistical significanceSignificant difference:we back transformed effect sizes to diffe

28、rences on a 10 cm visual analogue scale on the basis of a median pooled SD of 2.inconsistency between direct and indirect comparisonswas also need to be consideredConclusion37 SD units,corresponding to 0.Results from randomized trials about the effectiveness of chondroitin and glucosamine are confli

29、ctingThe 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 or long term.Glucosamine does not result in a relevant reduction of joint pain and function，nor affect joint space narrowing compared

30、with placebo.non-steroidal anti-inflammatory drugs was used as the pain killerThe 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 or long term.The study did not identify a subgroup for which

31、glucosamine showed any significant beneficial effects over placebo for pain or function in either the short term or long term.The 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 or long term.

32、joint space clinically important difference:SD of 1.Conclusion pThe 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 or long term.pStratification only for participants with knee OA or for type

33、 of glucosamine did not result in any differences in outcomes.pTherefore,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 basel

34、ine pain severity,BMI,sex,structural abnormalities and presence of inflammation Results from randomized trials about the effectiveness of chondroitin and glucosamine are conflictingjoint space clinically important difference:SD of 1.Thanks for your attention！inconsistency between direct and indirect

35、 comparisonswas also need to be consideredBMI,body massSome 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 effectjoint space clinically important difference:SD of 1.tests for i

36、nteraction were all negative(P0.Stratification only for participants with knee OA or for type of glucosamine did not result in any differences in outcomes.Eligibility criteria:Large scale randomized controlled trials in more than 200 patients with osteoarthritis of the knee or hip that compared gluc

37、osamine,chondroitin,or their combination with placebo or head to headRetrospective studyStatistical analysis:multivariable Bayesian hierarchical random effects modelsOsteoarthritis of hip and knee is increasingMeta-analysis1 mm)in favour of chondroitinWe prespecified a minimal clinically important d

38、ifference of 0.joint space clinically important difference:SD of 1.Impactor 20.Retrospective studyTake home messageNSAIs cause serious gastrointestinal and cardiovascular adverse events,especially with long term useGlobal sales：$2bn(1.Blue fgures represent high pain(WOMAC pain 70),high BMI(27 kg/m2)

39、,female sex,K&L grades 34 and presence of inflammation subgroups,respectively.Aim:to evaluate the effectiveness of oral glucosamine in subgroups of people with hip or knee osteoarthritis(OA)using individual patient dataStratification only for participants with knee OA or for type of glucosamine did

40、not result in any differences in outcomes.Impactor 20.General character:10 trials in 3803 patients were included.Meta-analysisGlucosamine was used to be thought as disease modifying agents and recommended for yearsThe study did not identify a subgroup for which glucosamine showed any significant ben

41、eficial effects over placebo for pain or function in either the short term or long term.Retrospective studyTake home messageConclusionTherefore,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

42、 glucosamine for clinically relevant subgroups of OA according to baseline pain severity,BMI,sex,structural abnormalities and presence of inflammationNSAIs cause serious gastrointestinal and cardiovascular adverse events,especially with long term use9 cm on a 10 cm visual analogue scale.Glucosamine

43、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 treatment of hip or knee OA in general and an absence of evidence to support the use of glucosamine

44、 for clinically relevant subgroups of OA according to baseline pain severity,BMI,sex,structural abnormalities and presence of inflammationtests for interaction were all negative(P0.Significant difference:we back transformed effect sizes to differences on a 10 cm visual analogue scale on the basis of

45、 a median pooled SD of 2.Red figures represent low pain(WOMAC pain 70),low BMI(27 kg/m2),male sex,K&L grades 02 and absence of inflammation subgroups,respectively.We believe it unlikely that future trials will show a clinically relevant benefit of any of the evaluated preparations37 SD units,corresp

46、onding to 0.Stratification only for participants with knee OA or for type of glucosamine did not result in any differences in outcomes.We believe it unlikely that future trials will show a clinically relevant benefit of any of the evaluated preparationsGlucosamine was used to be thought as disease m

47、odifying agents and recommended for years1 mm)in favour of chondroitin8bn)in 2008,60%compared with 2003,2013 reaching$2.Significant 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.The study did not identify a subgrou

48、p for which glucosamine showed any significant beneficial effects over placebo for pain or function in either the short term or long term.9 cm on a 10 cm visual analogue scale.inconsistency between direct and indirect comparisonswas also need to be consideredNSAIs cause serious gastrointestinal and

49、cardiovascular adverse events,especially with long term useSignificant 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.joint space clinically important difference:SD of 1.The study did not identify a subgroup for whi

50、ch glucosamine showed any significant beneficial effects over placebo for pain or function in either the short term or long term.tests for interaction were all negative(P0.joint space clinically important difference:SD of 1.Joint space:Results from randomized trials about the effectiveness of chondr