Benefits
Joint comfort in knee trials
In the NIH funded GAIT trial of 1,583 adults with knee osteoarthritis, which used chondroitin donated by this maker, 1,200 mg a day was not significantly better than placebo for knee pain. In a 3-month maker-sponsored trial of 129 adults who also had psoriasis, 800 mg a day eased knee pain and improved function more than placebo; in a 6-month trial of 69 adults, pain did not differ.
Knee cartilage on MRI
In a small 6-month trial of 69 adults with knee osteoarthritis, 800 mg a day led to less cartilage volume loss on MRI than placebo, and the difference persisted at 12 months. A 2-year maker-funded trial in 194 adults had no placebo group, only a comparison drug; it did not meet its main cartilage measure, though loss in the inner knee was smaller.
Pharmaceutical-grade and supplement-grade chondroitin
Bioibérica describes this ingredient as pharmaceutical grade. In a lab comparison, two pharmaceutical chondroitin products were 98 to 99.7% chondroitin, while three US joint supplements held 7 to 15% less than labeled plus keratan sulfate, another cartilage sugar. Purity alone does not show a larger benefit in people.
Combining with glucosamine
In the NIH funded GAIT trial, which used this maker's chondroitin, the chondroitin and glucosamine combination was not significantly better than placebo overall. In a 6-month maker-funded trial of 606 adults with painful knee osteoarthritis, the maker's combination product cut pain by about half, but with no placebo group the share due to the product is unknown.
Mechanism of action
Part of the cartilage matrix
Chondroitin sulfate is a glycosaminoglycan, a long chain of sugar units that is a natural part of cartilage. Supplements are extracted from animal cartilage, which is the rationale for taking it as a joint supplement.
Inflammatory signaling in cartilage cells (laboratory)
In cartilage cells exposed to interleukin-1 beta, chondroitin sulfate reduced p38 MAPK, Erk1/2 and NF-kappaB signaling and lowered IL-1 beta, TNF-alpha, COX-2 and NOS-2. These are cell and animal findings from a review partly written by Bioibérica staff, not effects measured in people.
Clinical trials
Multicenter, randomized, double-blind, placebo-controlled 24-week trial funded by the NIH and run under FDA drug rules, of sodium chondroitin sulfate 400 mg three times daily, glucosamine hydrochloride, both, or placebo, with a celecoxib arm as an active control. Bioibérica donated the chondroitin, which a US Veterans Affairs research pharmacy made into capsules. (Clegg et al. 2006, N Engl J Med)
1,583 adults with symptomatic knee osteoarthritis (mean age 59, 64% women); 1,229 with mild and 354 with moderate to severe pain.
Chondroitin alone was not significantly better than placebo at a 20% drop in knee pain: its response rate was 5.3 percentage points above the 60.1% placebo rate (P=0.17). The combination was 6.5 points higher (P=0.09); only an exploratory subgroup with moderate to severe pain responded more often to it (79.2% vs 54.3%). Adverse events were mild, infrequent and evenly spread.
Randomized, double-blind, placebo-controlled 3-month trial sponsored by Bioibérica (registry NCT00669123, product Condrosan) of chondroitin sulfate 800 mg a day. Primary outcomes: knee pain on a visual analogue scale and psoriasis severity. (Möller et al. 2010, Osteoarthritis Cartilage)
129 adults with symptomatic knee osteoarthritis who also had psoriasis.
Knee pain fell 26.9 mm with chondroitin vs 14.2 mm with placebo (P<0.01), the Lequesne function index improved more (4.8 vs 3.3 points, P<0.05), and fewer people needed acetaminophen (43% vs 64%). Overall psoriasis severity did not change significantly versus placebo. Adverse events were infrequent and evenly spread.
Investigator-initiated, randomized, double-blind, placebo-controlled pilot trial in Canada, supported in part by a Bioibérica grant, of chondroitin sulfate 800 mg once daily (Condrosan, CS Bio-Active, Bioibérica) for 6 months, then 6 months of open-label chondroitin for everyone. (Wildi et al. 2011, Ann Rheum Dis)
69 adults with knee osteoarthritis and clinical signs of synovitis.
On MRI, the chondroitin group lost less cartilage volume than the placebo group from 6 months (global knee P=0.030), and the difference persisted at 12 months; bone marrow lesion scores were lower in the lateral compartment at 12 months. Knee pain, WOMAC scores and quality of life did not differ from placebo at any time point.
Randomized, double-blind, double-dummy 2-year exploratory trial in Quebec, Canada, funded by Bioibérica, of pharmaceutical-grade chondroitin sulfate 1,200 mg once daily (Bioibérica; Condrosan in registry NCT01354145) compared with celecoxib 200 mg a day; there was no placebo group. Primary outcome: cartilage volume loss in the lateral compartment on MRI. (Pelletier et al. 2016, Arthritis Res Ther)
194 adults with knee osteoarthritis and synovitis; 138 had MRI data for the main analysis.
The primary outcome, lateral cartilage volume loss, did not differ between groups at 24 months. Medial compartment cartilage loss was smaller with chondroitin (6.3% vs 8.1%, P=0.018). Symptoms improved in both groups, which without a placebo group cannot be credited to either product. Safety was similar.
Multicenter, randomized, double-blind non-inferiority trial in France, Germany, Poland and Spain, funded by Bioibérica, of chondroitin sulfate 400 mg plus glucosamine hydrochloride 500 mg (Droglican, Bioibérica) three times a day compared with celecoxib 200 mg a day; there was no placebo group. (Hochberg et al. 2016, Ann Rheum Dis)
606 adults with knee osteoarthritis and moderate to severe knee pain.
WOMAC pain fell by about half in both groups over 6 months (50.1% and 50.2%), meeting the trial's prespecified margin. Without a placebo group, the trial cannot show how much of the drop was due to the combination. Adverse events were low and similar between groups.