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Treatment of osteoarthritis with unspecific symptomatic agents is not satisfactory and burdened with safety issues. The use of glucosamine and/or chondroitin as disease-modifying agents is increasingly popular, despite conflicting clinical trial evidence with the many available products. Wandel and colleagues produced a systematic review and a meta-analysis with relatively new statistical methods.
Randomised clinical trials were searched from standard sources. There was apparently no attempt to retrieve original study data from investigators/sponsors. Only large placebo-controlled trials with ≥100 patients with knee or hip osteoarthritis per arm were selected (seven for glucosamine and four for chondroitin) and analysed. There was little attempt to critically appraise them, and unfortunately they were not appraised for product status (prescription, over-the-counter (OTC), supplement), pharmaceutical formulation, daily dose regimen (in the context of minimally acceptable total dose) or trial duration. Trials were pooled and meta-analysed according to a complex Bayesian approach with ‘network’ meta-analysis of each compound versus placebo: this is usually used for indirect comparisons between interventions and not as employed by the authors. They used a random effect model …
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