Efficacy and safety of glucosamine sulfate in the management of osteoarthritis: Evidence from real-life setting trials and surveys

Semin Arthritis Rheum. 2016 Feb;45(4 Suppl):S12-7. doi: 10.1016/j.semarthrit.2015.11.011. Epub 2015 Dec 2.


The European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) treatment algorithm recommends chronic symptomatic slow-acting drugs for osteoarthritis (SYSADOAs) including glucosamine sulfate (GS) and chondroitin sulfate (CS) as first-line therapy for knee osteoarthritis (OA). Numerous studies are published on the use of SYSADOAs in OA; however, the efficacy of this class is still called into question largely due to the regulatory status, labeling and availability of these medications which differ substantially across the world. Examination of the evidence for the prescription patented crystalline GS (pCGS) formulation at a dose of 1500mg once-daily demonstrates superiority over other GS and glucosamine hydrochloride (GH) formulations and dosage regimens. Thus, the ESCEO task force advocates differentiation of prescription pCGS over other glucosamine preparations. Long-term clinical trials and real-life studies show that pCGS may delay joint structural changes, suggesting potential benefit beyond symptom control when used early in the management of knee OA. Real-life pharmacoeconomic studies demonstrate a long-term reduction in the need for additional pain analgesia and non-steroidal anti-inflammatory drugs (NSAIDs) with pCGS, with a significant reduction of over 50% in costs associated with medications, healthcare consultations and examinations over 12 months. Furthermore, treatment with pCGS for at least 12 months leads to a reduction in the need for total joint replacement for at least 5 years following treatment cessation. Thus, pCGS (1500mg od) is a logical choice to maximize clinical benefit in OA patients, with demonstrated medium-term control of pain and lasting impact on disease progression.

Keywords: Chondroitin; Glucosamine; Knee osteoarthritis; Symptomatic slow-acting drugs for osteoarthritis (SYSADOAs).

Publication types

  • Practice Guideline
  • Review

MeSH terms

  • Aged
  • Chondroitin Sulfates / economics
  • Chondroitin Sulfates / therapeutic use*
  • Drug Therapy, Combination
  • Evidence-Based Medicine
  • Glucosamine / economics
  • Glucosamine / pharmacokinetics
  • Glucosamine / therapeutic use*
  • Humans
  • Middle Aged
  • Musculoskeletal Pain / prevention & control*
  • Osteoarthritis, Knee / drug therapy*
  • Randomized Controlled Trials as Topic


  • Chondroitin Sulfates
  • Glucosamine