Comparison of approaches to chondroprotective therapy based on the analysis of clinical recommendations from different countries

Currently, with osteoarthritis (OA), numerous over-the-counter and prescription drugs are used, as well as biologically active additives (BAA). Significant market share in Russia are: chondroitin sulfate, glycosaminoglycan-peptide complex and Alflutop.

The purpose of the article is to compare the clinical recommendations of the professional communities of doctors of the Russian Federation, countries of Europe, Great Britain, the USA, Canada, Australia on approaches to chondroprotective therapy/SYSADOA for osteoarthritis using the example of chondroitin sulfate, glycosamine glycan-peptide complex and Alflutop.

Materials and methods: The analysis included 11 clinical recommendations (guideline) from 2008 to 2019 on the management of patients with OA.

Results: The glycosaminoglycan-peptide complex (Rumalon) and Alflutop were recommended by the Russian Scientific Medical Society of Therapists (RNMOT), but are not mentioned in the recommendations of several Russian professional communities. In the European recommendations, the glycosaminoglycan-peptide complex and the drug Alflutop are not considered. Chondroitin sulfate to reduce the symptoms of OA is recommended by 5 professional guideline. With the exception of Russian recommendations, the listed professional communities recommend the use of chondroitin sulfate only as a “pharmaceutical quality drug”.

Conclusion: It is advisable to agree on Russian recommendations on the use of the drugs in question. At the level of foreign and Russian professional communities, particular attention is required to analysis of data on the use of chondroitin sulfate, taking into account the quality of production, the composition of active substances and bioavailability, the quantitative content of active substances and the quality of substances. It is necessary to systematize the products with a separate assessment of the effectiveness of registered medicines, biologically active additives of pharmaceutical quality and low-quality products with minimal bioavailability. 

1. Alekseeva L.I., Kashevarova N.G., Taskina E.A. (Work Team). Osteoarthrosis: clinical guidelines. All-Russian Public Organization “Association of Rheumatologists of Russia”; 2016. (In Russ.) Available at: http://kokb45.ru/wp-content/uploads/2018/06/Osteoartroz.pdf.

2. Kloppenburg M., Kroon F.P., Blanco F.J., Doherty M., Dziedzic K.S., Greibrokk E., et al. 2018 update of the EULAR recommendations for the management of hand osteoarthritis. Ann Rheum Dis. 2019;78(1):16-24. doi: 10.1136/annrheumdis-2018-213826.

3. Bruyere O., Honvo G., Veronese N., Arden N.K., Branco J., Curtis E.M. et al. An updated algorithm recommendation for the management of knee osteoarthritis from the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Semin Arthritis Rheum. 2019;49(3):337-350. doi: 10.1016/j.semarthrit.2019.04.008.

4. Sidorova I. Chondroprotective market overview for the first half of 2013. Remedium. 2013;(9):39-43. (In Russ.) Available at: https://www.remedium.ru/state/na-zashchite-sustavov/?PAGEN_4=3.

5. The Royal Australian College of General Practitioners. Guideline for the management of knee and hip osteoarthritis. 2nd ed. East Melbourne, Vic: RACGP; 2018. Available at: https://www.racgp.org.au/FSDEDEV/media/documents/Clinical%20Resources/Guidelines/Joint%20replacement/ Guideline-for-the-management-of-knee-and-hip-OA-2nd-edition.pdf.

6. Yabuki S., Ip A.K.K., Tam C.K., Murakami T., Ushida T., Wang J.H., Shin H.K., Sun W.Z., Williamson O.D. Evidence-Based Recommendations on the Pharmacological Management of Osteoarthritis and Chronic Low Back Pain: An Asian Consensus. Asian J Anesthesiol. 2019;57(2):37-54. doi: 10.6859/aja.201906_57(2).0003.

7. Naumov A.V., Alekseeva L.I. Russian Scientific Medical Society of Therapists. Management of patients with osteoarthritis and comorbidity in general medical practice: clinical guidelines. Moscow; 2016. 40 p. (In Russ.) Available at: https://medvestnik.ru/apps/mv/assets/uploads/%D0%A1%D1%82%D0%B0%D1%82%D1%8C%D0%B8/REK-osteo2016.pdf.

8. Alekseeva L.I., Naumov A.V. Management of osteoarthritis with comorbidity in general medical practice (clinical guidelines). Doktor.Ru = Doctor.Ru. 2017;5(134):51-69. (In Russ.) Available at: https://journaldoctor.ru/archive/kardiologiya/doktor-ru-5-134-2017-kardiologiya-terapiya/.

9. Hochberg M.C., Altman R.D., April K.T., et al American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 2012;64(4):465-474. doi: 10.1002/acr.21596.

10. Manara M., Bortoluzzi A., Favero M., Prevete I., Scire C.A., Bagnato G. et al. Italian Society for Rheumatology recommendations for the management of hand osteoarthritis. Italian Society for Rheumatology. Reumatismo. 2013;65(4):167-185. doi: 10.4081/reumatismo.2013.167.

11. Kielly J., Davis E.M., Marra C. Practice guidelines for pharmacists: The management of osteoarthritis. Can Pharm J (Ott). 2017;150(3):156-168. doi: 10.1177/1715163517702168.

12. Bannuru R.R., Osani M.C., Vaysbrot E.E., Arden N.K., Bennell K., Bierma-Zeinstra S.M.A. et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019;27(11):1578-1589. doi: 10.1016/j.joca.2019.06.011.

13. NICE. Osteoarthritis: Care and management in adults. London: National Clinical Guideline Centre; 2014. Available at: https://www.nice.org.uk/guidance/CG177.

14. Newberry S.J., FitzGerald J., SooHoo N.F., Booth M., et al. Treatment of Osteoarthritis of the Knee: An Update Review. Rockville (MD): Agency for Healthcare Research and Quality (US); 2017. Report No.: 17-EHC011-EF. doi: 10.23970/AHRQEPCCER190.

15. Lin K.W. Treatment of Knee Osteoarthritis. Am Fam Physician. 2018;98(9):603-606. Available at: https://www.aafp.org/afp/2018/1101/p603.html.

16. Haddad Gh., Baseman H.S., Calvaresi D., Lamb L. et al. Quality Risk Manager for Manufacturing Systems. Technical Report No 54-5. Parenteral Drug Association; 2017. Available at: https://store.pda.org/TableOfContents/TR54-5_TOC.pdf.

17. Restaino O.F., Finamore R., Stellavato A., Diana P. et al. European chondroitin sulfate and glucosamine food supplements: A systematic quality and quantity assessment compared to pharmaceuticals. Carbohydr Polym. 2019;15(222):114-984. doi: 10.1016/j.carbpol.2019.114984.

18. Stellavato A., Restaino O.F., Vassallo V., Finamore R. et al. Comparative Analyses of Pharmaceuticals or Food Supplements Containing Chondroitin Sulfate: Are Their Bioactivities Equivalent? Adv Ther. 2019;36(11):3221-3237. doi: 10.1007/s12325-019-01064-8.

19. Honvo G., Bruyere O., Reginster J.-Y. Update on the role of pharmaceuticalgrade chondroitin sulfate in the symptomatic management of knee osteoarthritis Aging Clin Exp Res. 2019;31(8):1163-1167. doi: 10.1007/s40520-019-01253-z.