The use of symptomatic slow-acting drugs for the medium as well as long-term management of osteoarthritis (OA) has become widespread these days. These symptomatic slow-acting drugs for OA (SYSADOAs) are recommended due to their capability to delay joint structural changes, control pain and improving function. Sukit Saen and colleagues recently conducted a review to assess if patented crystalline glucosamine sulfate (pCGS) should be differentiated from other glucosamine preparations for OA treatment. The investigators found the highest data for pCGS formulation among all SYSADOAs.

Glucosamine is commonly available as Glucosamine sulfate (GS), and Glucosamine hydrochloride (GH). These forms differ mainly in the molecular form, pharmaceutical formulation, and dose regimen. pCGS is the only formulation given as a highly bioavailable once-daily dose (1500 mg). It rapidly achieves the plasma levels of around 10 μmol/L needed to restrain the interleukin-1-induced expression of genes implicated in the pathophysiology of joint pain and tissue damage.

The pieces of evidence showed that pCGS is the only formulation which grants a reasonable effect size on pain which is superior to paracetamol and comparable to NSAIDs, while non-crystalline GS and GH fail to provide any statistically significant improvement in pain. The review also reported that the long-term treatment with pCGS causes substantial disease-modifying outcomes with a decline in the need for total joint replacement lasting for five years after the end of treatment. The studies also showed that the use of pCGS was associated with the long-term reduction in additional pain analgesia and NSAIDs, with a 50% decline in costs of other OA medication and healthcare consultations.

The overall results of this review suggest pCGS be a judicious choice with proven benefit in reducing pain and disease progression. There is a need to educate physicians and patients about the preference of pCGS over other glucosamine formulations which will aid in improving treatment choices, enhance treatment adherence, and optimize clinical benefit in OA.