《氨糖在骨关节炎中的应用课件.pptx》由会员分享，可在线阅读，更多相关《氨糖在骨关节炎中的应用课件.pptx（30页珍藏版）》请在三一办公上搜索。
1、Osteoarthritis of hip and knee is increasingnon-steroidal anti-inflammatory drugs was used as the pain killerNSAIs cause serious gastrointestinal and cardiovascular adverse events, especially with long term useGlucosamine was used to be thought as disease modifying agents and recommended for yearsGl
2、obal sales：$2bn (1.3bn, 0.8bn) in 2008, 60% compared with 2003, 2013 reaching $2.3bnResults from randomized trials about the effectiveness of chondroitin and glucosamine are conflicting,Introduction,Osteoarthritis of hip and knee,Article #1,2010 . BMJImpactor 20.75,Article #12010 . BMJ,Article #1,Ai
3、m: 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 kneeDesign: network meta-analysisOutcomes: pain release, change in minimal width of joint space Eligibility criteria: Large scale
4、 randomized controlled trials in more than 200 patients with osteoarthritis of the knee or hip that compared glucosamine, chondroitin, or their combination with placebo or head to headGeneral character: 10 trials in 3803 patients were included.,Article #1Aim: To determine th,Method,Statistical analy
5、sis: multivariable Bayesian hierarchical random effects modelsSignificant difference: we back transformed effect sizes to differences on a 10 cm visual analogue scale on the basis of a median pooled SD of 2.5 cm found in large scale osteoarthritis trials that assessed pain on a 10 cm visual analogue
6、 scale.We prespecified a minimal clinically important difference of 0.37 SD units, corresponding to 0.9 cm on a 10 cm visual analogue scale. joint space clinically important difference : SD of 1.2 mm,Method Statistical analysis: m,Result,Result,Result,Result,Result,Result,Result,tests for interactio
7、n were all negative (P0.20 for interaction),Result tests for interaction w,Result,Joint space: The difference was -0.2 mm (-0.3 to 0.0 mm) in glucosamine-0.1 mm (-0.3 to 0.1 mm) in favour of chondroitin 0.0 mm (-0.2 to 0.2 mm) for the combination,Result Joint space:,Conclusion,We believe it unlikely
8、 that future trials will show a clinically relevant benefit of any of the evaluated preparations 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. Some patients, howev
9、er, are convinced that these preparations are beneficial, which might be because of the natural course of osteoarthritis, regression to the mean, or the placebo effect,Conclusion We believe it unlik,Limitations,Meta-analysisheterogeneity between trials needed to be consideredinconsistency between di
10、rect and indirect comparisonswas also need to be considered,LimitationsMeta-analysis,Article #2,2017 . ARD (Ann Rheum Dis ): 12.811Level of Evidence Level IRetrospective study,Article #22017 . ARD (Ann Rheu,Article #2,Aim: to evaluate the effectiveness of oral glucosamine in subgroups of people with
11、 hip or knee osteoarthritis (OA) using individual patient data Design: retrospective study with individual patient data (IPD)Outcomes: pain and function,Article #2Aim: to evaluate the,Result,Result,Result,Result,Result,Result,NSAIs cause serious gastrointestinal and cardiovascular adverse events, es
12、pecially with long term useWe prespecified a minimal clinically important difference of 0.Thanks for your attention！20 for interaction)Blue fgures represent high pain (WOMAC pain 70), high BMI (27 kg/m2), female sex, K&L grades 34 and presence of inammation subgroups, respectively.Significant differ
13、ence: we back transformed effect sizes to differences on a 10 cm visual analogue scale on the basis of a median pooled SD of 2.General character: 10 trials in 3803 patients were included.The difference was -0.Design: retrospective study with individual patient data (IPD)tests for interaction were al
14、l negative (P0.tests for interaction were all negative (P0.Statistical analysis: multivariable Bayesian hierarchical random effects modelstests for interaction were all negative (P0.Aim: to evaluate the effectiveness of oral glucosamine in subgroups of people with hip or knee osteoarthritis (OA) usi
15、ng individual patient dataSome 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 effectRed figures represent low pain (WOMAC pain 70), low BMI (27 kg/m2), male sex, K&L grade
16、s 02 and absence of inammation subgroups, respectively.Glucosamine does not result in a relevant reduction of joint pain and function，nor affect joint space narrowing compared with placebo.The study did not identify a subgroup for which glucosamine showed any significant beneficial effects over plac
17、ebo for pain or function in either the short term or long term.Stratification only for participants with knee OA or for type of glucosamine did not result in any differences in outcomes.Thanks for your attention！,Result,NSAIs cause serious gastrointe,Result,Result,Result,Result,Result,Red figures re
18、present low pain (WOMAC pain 70), low BMI (27 kg/m2), male sex, K&L grades 02 and absence of inammation subgroups, respectively. Blue fgures represent high pain (WOMAC pain 70), high BMI (27 kg/m2), female sex, K&L grades 34 and presence of inammation subgroups, respectively. BMI, body mass,Result R
19、ed figures represent,Result,No statistical significance main effects were found for glucosamine over placebo None of the interaction terms of the predefined subgroupsreached statistical significance,Result No statistical signific,Conclusion,The study did not identify a subgroup for which glucosamine
20、 showed any significant beneficial effects over placebo for pain or function in either the short term or long term. Stratification only for participants with knee OA or for type of glucosamine did not result in any differences in outcomes. Therefore, currently, there is no evidence to support the us
21、e 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, BMI, sex, structural abnormalities and presence of inflammation,Conclusion The study did not i,Take ho
22、me message,Glucosamine does not result in a relevant reduction of joint pain and function，nor affect joint space narrowing compared with placebo. Some patients, however, are convinced that these preparations are beneficial, which might be because of the natural course of osteoarthritis, or the place
23、bo effect,Take home messageGlucosamine d,Thanks for your attention！,Thanks for your attention！,Article #1,2010 . BMJImpactor 20.75,Article #12010 . BMJ,Result,Result,Design: retrospective study with individual patient data (IPD)Outcomes: pain and functionStratification only for participants with kne
24、e OA or for type of glucosamine did not result in any differences in outcomes.NSAIs cause serious gastrointestinal and cardiovascular adverse events, especially with long term useOur findings indicate that glucosamine, chondroitin, and their combination do not result in a relevant reduction of joint
25、 pain nor affect joint space narrowing compared with placebo.Blue fgures represent high pain (WOMAC pain 70), high BMI (27 kg/m2), female sex, K&L grades 34 and presence of inammation subgroups, respectively.ConclusionDesign: retrospective study with individual patient data (IPD)We prespecified a mi
26、nimal clinically important difference of 0.Aim: to evaluate the effectiveness of oral glucosamine in subgroups of people with hip or knee osteoarthritis (OA) using individual patient dataheterogeneity between trials needed to be consideredThe difference was -0.Stratification only for participants wi
27、th knee OA or for type of glucosamine did not result in any differences in outcomes.Impactor 20.NSAIs cause serious gastrointestinal and cardiovascular adverse events, especially with long term useLimitationsjoint space clinically important difference : SD of 1.Therefore, currently, there is no evid
28、ence 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, BMI, sex, structural abnormalities and presence of inflammationThe study did not
29、 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.1 mm) in favour of chondroitin,Result,Design: retrospective study wi,Result,Result,Conclusion,The study did not identify a subgroup for which g
30、lucosamine showed any significant beneficial effects over placebo for pain or function in either the short term or long term. Stratification only for participants with knee OA or for type of glucosamine did not result in any differences in outcomes. Therefore, currently, there is no evidence to supp
31、ort 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, BMI, sex, structural abnormalities and presence of inflammation,Conclusion The study did not
32、 i,The difference was -0.The difference was -0.Some patients, however, are convinced that these preparations are beneficial, which might be because of the natural course of osteoarthritis, or the placebo effectThe difference was -0.LimitationsLimitationsThe difference was -0.Results from randomized
33、trials about the effectiveness of chondroitin and glucosamine are conflictingBMI, body massAim: to evaluate the effectiveness of oral glucosamine in subgroups of people with hip or knee osteoarthritis (OA) using individual patient dataWe prespecified a minimal clinically important difference of 0.De
34、sign: retrospective study with individual patient data (IPD)Limitationsheterogeneity between trials needed to be consideredGlucosamine was used to be thought as disease modifying agents and recommended for yearsImpactor 20.Impactor 20.ConclusionBlue fgures represent high pain (WOMAC pain 70), high B
35、MI (27 kg/m2), female sex, K&L grades 34 and presence of inammation subgroups, respectively.General character: 10 trials in 3803 patients were included.,NSAIs cause serious gastrointestinal and cardiovascular adverse events, especially with long term usenon-steroidal anti-inflammatory drugs was used
36、 as the pain killer20 for interaction)Glucosamine does not result in a relevant reduction of joint pain and function，nor affect joint space narrowing compared with placebo.Impactor 20.Therefore, currently, there is no evidence to support the use of glucosamine for treatment of hip or knee OA in gene
37、ral 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 inflammation20 for interaction)Design: retrospective study with individual patient data (IPD)Glucosamine do
38、es not result in a relevant reduction of joint pain and function，nor affect joint space narrowing compared with placebo.The difference was -0.Global sales：$2bn (1.Limitationstests for interaction were all negative (P0.Thanks for your attention！The study did not identify a subgroup for which glucosam
39、ine 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 with placebo.Therefore, currently, there is no evidence to su
40、pport 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, BMI, sex, structural abnormalities and presence of inflammationMeta-analysisThanks for you
41、r attention！Blue fgures represent high pain (WOMAC pain 70), high BMI (27 kg/m2), female sex, K&L grades 34 and presence of inammation subgroups, respectively.,Thanks for your attention！heterogeneity between trials needed to be considered1 mm) in favour of chondroitinnon-steroidal anti-inflammatory
42、drugs was used as the pain killerTherefore, 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, BMI, sex,
43、 structural abnormalities and presence of inflammationheterogeneity between trials needed to be consideredBlue fgures represent high pain (WOMAC pain 70), high BMI (27 kg/m2), female sex, K&L grades 34 and presence of inammation subgroups, respectively.The difference was -0.Some patients, however, a
44、re convinced that these preparations are beneficial, which might be because of the natural course of osteoarthritis, or the placebo effectRed figures represent low pain (WOMAC pain 70), low BMI (27 kg/m2), male sex, K&L grades 02 and absence of inammation subgroups, respectively.The difference was -
45、0.The difference was -0.Outcomes: pain release, change in minimal width of joint spaceWe prespecified a minimal clinically important difference of 0.37 SD units, corresponding to 0.1 mm) in favour of chondroitinSignificant difference: we back transformed effect sizes to differences on a 10 cm visual
46、 analogue scale on the basis of a median pooled SD of 2.Aim: to evaluate the effectiveness of oral glucosamine in subgroups of people with hip or knee osteoarthritis (OA) using individual patient dataMeta-analysisNo statistical significance main effects were found for glucosamine over placebo,ARD (A
47、nn Rheum Dis ): 12.Statistical analysis: multivariable Bayesian hierarchical random effects modelsThe 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 difference was -0.Global
48、 sales：$2bn (1.Design: retrospective study with individual patient data (IPD)Aim: to evaluate the effectiveness of oral glucosamine in subgroups of people with hip or knee osteoarthritis (OA) using individual patient data37 SD units, corresponding to 0.37 SD units, corresponding to 0.Glucosamine was
49、 used to be thought as disease modifying agents and recommended for yearsDesign: retrospective study with individual patient data (IPD)Some patients, however, are convinced that these preparations are beneficial, which might be because of the natural course of osteoarthritis, regression to the mean,
50、 or the placebo effectThanks for your attention！Thanks for your attention！We prespecified a minimal clinically important difference of 0.Aim: to evaluate the effectiveness of oral glucosamine in subgroups of people with hip or knee osteoarthritis (OA) using individual patient dataThe difference was
