Comparison of celebrex, glucosamine, glucosamine chondroitin and placebo

The University of Utah School of Medicine has published a review looking at the popular supplement, glucosamine, and its efficacy in comparison to celebrex, placebo, and the combination of glucosamine-condroitin.
http://www.ncbi.nlm.nih.gov/pubmed/20525840
Ann Rheum Dis. 2010 Aug;69(8):1459-64.
"Clinical efficacy and safety of glucosamine, chondroitin sulphate, their combination, celecoxib or placebo taken to treat osteoarthritis of the knee: 2-year results from GAIT."

Osteoarthritis is a significant cause of disability, and knee osteoarthritis is one of the more prevalent subsets of debilitating osteoarthritis. The methods of the study are as follows.
"METHODS: A 24-month, double-blind, placebo-controlled study, conducted at nine sites in the US ancillary to the Glucosamine/chondroitin Arthritis Intervention Trial, enrolled 662 patients with knee OA who satisfied radiographic criteria (Kellgren/Lawrence grade 2 or 3 changes and baseline joint space width of at least 2 mm). This subset continued to receive their randomised treatment: glucosamine 500 mg three times daily, CS 400 mg three times daily, the combination of glucosamine and CS, celecoxib 200 mg daily, or placebo over 24 months. The primary outcome was a 20% reduction in Western Ontario and McMaster University Osteoarthritis Index (WOMAC) pain over 24 months. Secondary outcomes included an Outcome Measures in Rheumatology/Osteoarthritis Research Society International response and change from baseline in WOMAC pain and function."

Their conclusions were as follows.
"CONCLUSIONS: Over 2 years, no treatment achieved a clinically important difference in WOMAC pain or function as compared with placebo. However, glucosamine and celecoxib showed beneficial but not significant trends. Adverse reactions were similar among treatment groups and serious adverse events were rare for all treatments."

From this study, though glucosamine and celecoxib achieved some benefit, it was not significant. In my practice I have had patients' have GI problems with celecoxib, which is anecdotal, of course. As with all supplements, or medications, each person reacts differently, so it is important to keep an open mind and try the safest solutions first. From this study, if patients wanted to try a supplement, I could recommend glucosamine with the same enthusiasm as celebrex, but might urge them to try the avocado and soybean unsaponifiables (ASU) from yesterday's post. Of course, there are many more targeted herbal therapies, but don't have the benefit of clinical studies behind them.