葡萄糖胺和软骨素补充剂的临床有效性放缓或逮捕膝骨关节炎的进展:系统回顾和经济评价。
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黑色C, C明白”,亨德森R, MacEachern C,麦克纳米P, Quayyum Z,罗伊尔P,托马斯
葡萄糖胺和软骨素补充剂的临床有效性放缓或逮捕膝骨关节炎的进展:系统回顾和经济评价。
健康评估生物抛光工艺。2009年11月,13 (52):1 - 148。doi: 10.3310 / hta13520。
- PubMed ID
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19903416 (在PubMed]
- 文摘
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目的:评估临床疗效和成本效益的硫酸氨基葡萄糖/盐酸和硫酸软骨素在修改膝骨关节炎(OA)的发展。数据来源:电子数据库搜索从1950年到2008年,包括:MEDLINE和PubM必威国际apped;EMBASE;Cochrane图书馆(包括Cochrane系统评价数据库,中央,敢,NHS水平速度和数据库);盟军和补充医学(艾湄湾);国家研究注册(NRR)必威国际app;Web的科学程序;当前的对照试验;和临床Trials.gov。其他来源包括书目检索文件,注册但未发表的试验,互联网搜索和英国食品标准局的网站。必威国际app REVIEW METHODS: A search was conducted for systematic reviews of randomised controlled trials (RCTs), which were used to identify RCTs of at least 12 months' duration and updated with searches for primary studies. A cost-effectiveness model was constructed using cohort simulation and drawing on available evidence. Sensitivity analysis was undertaken and value of information analysis conducted. A review of studies of mechanism of action was carried out to explore the biological plausibility of the preparations. RESULTS: Five systematic reviews and one clinical guideline met the inclusion criteria. They reported inconsistent conclusions with only modest effects on reported pain and function. A reduction in joint space narrowing was more consistently observed, but the effect size was small and the clinical significance uncertain. A separate review of eight primary trials of > 12 months' duration showed evidence of statistically significant improvements in joint space loss, pain and function for glucosamine sulphate, but the clinical importance of these differences was not clear. In two studies of glucosamine sulphate, the need for knee arthroplasty was reduced from 14.5% to 6.3% at 8 years' follow-up. For other preparations of glucosamine, chondroitin and combination therapy, there was less evidence to support a clinical effect. Cost-effectiveness modelling was restricted to glucosamine sulphate. Over a lifetime horizon the incremental cost per quality-adjusted life-year (QALY) gain for adding glucosamine sulphate to current care was estimated to be 21,335 pounds. Deterministic sensitivity analysis suggested that the cost-effectiveness of glucosamine sulphate therapy was particularly dependent on the magnitude of the quality of life (QoL) gain, the change in knee arthroplasty probability with therapy and the discount rate. At a cost per QALY gained threshold of 20,000 pounds, the likelihood that glucosamine sulphate is more cost-effective than current care is 0.43, while at a threshold of 30,000 pounds, the probability rises to 0.73. Probabilistic sensitivity analysis showed that estimates were imprecise and subject to a degree of decision uncertainty. Value of information analysis demonstrated the need for further research. Several biologically plausible mechanisms of action for glucosamine sulphate and chondroitin were proposed. CONCLUSIONS: There was evidence that glucosamine sulphate shows some clinical effectiveness in the treatment of OA of the knee. No trial data came from the UK and caution should be exercised in generalising the findings to the UK health-care setting. Cost-effectiveness was not conclusively demonstrated. There was evidence to support the potential clinical impact of glucosamine sulphate. The value of information analysis identified three research priorities: QoL, structural outcomes and knee arthroplasty. The biological mechanism of glucosamine sulphate and chondroitin remains uncertain and, in particular, the proposal that the active substance may be sulphate should be explored further.
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