Eficácia e segurança da combinação Glicosamina e Condroitina comparada a medicamentos disponíveis no SUS para o tratamento de osteoartrite: revisão rápida / Effectiveness and safety of Glucosamine and Chondroitin combination compared to drugs available in Brazilian Public Health System for the treatment of Osteoarthritis: rapid review

Tecnologia: Combinação de glicosamina e condroitina. Indicação: Tratamento de osteoartrite em adultos. Pergunta: O tratamento com a combinação de glicosamina e condroitina é mais eficaz e seguro que os demais tratamentos para osteoartrite disponíveis no SUS? Métodos: Uma revisão rápida de evidências, uma revisão de revisões sistemáticas, com levantamento bibliográfico realizado na base de dados PUBMED, utilizando estratégia estruturada de busca. A qualidade metodológica das revisões sistemáticas foi avaliada com AMSTAR-2. Resultados: Foi selecionada uma revisão sistemática, que atendiam aos critérios de inclusão. Conclusão: A combinação de glicosamina com condroitina, comparados ao placebo, mostrou ser mais eficaz para tratamento da dor e função e alcançou o segundo lugar nas alternativas terapêuticas para tratamento da dor e função

Technology: Combination of glucosamine and chondroitin. Indication: Treatment of osteoarthritis in adults. Question: Is the treatment with the combination of glucosamine and chondroitin more effective and safer than the other treatments for osteoarthritis available in the Brazilian Public Health System? Methods: A rapid review of evidence, a overview of systematic reviews, with bibliographic search done in PUBMED database, using a structured search strategy. The methodological quality of systematic reviews was assessed using AMSTAR-2. Results: A systematic review was selected, which met the inclusion criteria. Conclusion: The combination of glucosamine and chondroitin, compared to placebo, proved to be more effective for the treatment of pain and function and reached second place in therapeutic alternatives for the treatment of pain and function

Development and validation of a HILIC-HPLC-ELSD method for simultaneous determination of glucosamine hydrochloride and chondroitin sulfate in dietary supplements

Abstract The objective of the present study is to develop and validate a simple, selective and accurate hydrophilic interaction liquid chromatography - a high performance liquid chromatography incorporating an evaporative light scattering detector (HILIC-HPLC-ELSD) method for simultaneously determining glucosamine hydrochloride and chondroitin sulfate in dietary supplements. The chromatographic separation was carried out on a ZIC-HILIC column (150 mm x 4.6 mm x 5µm) in isocratic system mode with a mobile phase of acetonitrile, 30 mM ammonium formate and water (77:20:3, v/v/v) at pH 4.5, a column temperature of 35°C, a flow rate of 1 mL.min-1, and an injection volume of 5 µL. An evaporative light scattering (ELS) detector was used. Effective separation was achieved by means of analyte resolution of more than 1.5 with an analysis run time of approximately 20 minutes. The linearity of glucosamine hydrochloride and chondroitin sulfate ranged from 0.4 to 2.5 mg.mL-1. The limits of the detection and quantification of glucosamine hydrochloride were 20 and 80 mg.mL-1 respectively, while for chondroitin sulfate they were 80 and 400 mg.mL-1. All validation parameters satisfied the acceptance criteria in accordance with International Conference on Harmonisation (ICH) guidelines. The method was successfully applied to the assay of commercial dietary supplement samples

Treatment of knee osteoarthritis with a new formulation of a fixed-dose combination of glucosamine sulfate and bovine chondroitin: a multicenter, randomized, single-blind, non-inferiority clinical trial

Abstract Objectives: To compare the efficacy and safety of a new formulation of a fixed dose combination of glucosamine sulfate (GS; 1500 mg) and bovine chondroitin sulfate (CS; 1200 mg) versus the reference product (RP) in patients with knee osteoarthritis (OA). Methods: In this multicenter, randomized, single-blind trial, 627 patients with knee osteoarthritis (OA)—Kellgren-Lawrence grades 2 or 3 and mean score ≥ 40 mm in the WOMAC pain subscale—were randomized to receive GS/ CS or the RP for 24 weeks. The primary efficacy endpoint was the absolute change in WOMAC pain subscale score. The secondary endpoints included the following: WOMAC total and subscale scores, overall assessment of the disease by the patient and the investigator, SF-12 score, OMERACT-OARSI response rate to the treatment, and rescue medication use. Results: Mean reductions of WOMAC pain score were - 35.1 (sd = 23.2) mm in the GS/CS group and - 36.5 (sd = 24.9) mm in the RP group. The difference between the adjusted means of both treatments confirmed the noninferiority of GS/CS versus the RP. Improvement was observed in pain, stiffness, physical function and total WOMAC score, as well as in overall OA assessment by the patient and the investigator for both groups. No improvement was observed in SF-12. The rate of OMERACT-OARSI responders was 89.4% in GS/CS group and 87.9% in the RP group. Headache and changes in glucose tolerance were the most frequent treatment-related adverse events. Conclusions: The new formulation of a fixed-dose combination of glucosamine sulfate and bovine chondroitin sulfate was non-inferior to the RP in symptomatic treatment of knee OA, with a high responder rate and good tolerability profile. Trial registration: ClinicalTrials.gov; Registration number NCT02830919; Date of registration: July 13, 2016; First randomization date: December 05, 2016).(AU)

Reducción de la cobertura social para los fármacos antiartrósicos sintomáticos de acción lenta: una iniciativa de desinversión en Argentina, 2015-2017 / Reduction of social coverage for symptomatic slow-acting drugs for osteoarthritis: a disinvestment initiative in Argentina, 2015-2017

RESUMEN En abril de 2016, el Instituto Nacional de Servicios Sociales para Jubilados y Pensionados excluyó del subsidio social la cobertura al 100% de 159 fármacos, entre ellos, los antiartrósicos sintomáticos de acción lenta o symptomatic slow-acting drugs for osteoarthritis (SySADOA), por insuficiente evidencia de beneficio clínico significativo. Evaluamos el efecto de esta medida sobre la utilización de SySADOA y de los antiinflamatorios no esteroides (AINE), no afectados por la medida. Se compararon las dispensas ambulatorias de los SySADOA y los AINE de 2015 a 2017, midiendo unidades dispensadas, precio de venta al público y gasto de bolsillo del beneficiario para cada mes. Luego de la medida, descendieron un 61,6% los envases de SySADOA dispensados y un 63,4% el monto total del precio de venta al público, medido en valores constantes. La dispensa no se reorientó hacia los AINE, que descendieron un 6,1%. Disminuyó tanto la incidencia de nuevos tratamientos (de 6,4 a 3,3 tratamientos por 1.000 beneficiarios por mes) como su continuidad. El gasto de bolsillo de los beneficiarios en SySADOA aumentó un 75,8% (a valores constantes). La desinversión en intervenciones de valor terapéutico cuestionable es una herramienta valiosa para la sustentabilidad de los sistemas de salud.

ABSTRACT In April 2016, the National Institute of Social Services for Retirees and Pensioners discontinued its policy of 100% coverage for 159 drugs (the "social subsidy"), including symptomatic slow-acting drugs for osteoarthritis (SYSADOAs), due to insufficient evidence of significant clinical benefit. We evaluated the effect of this measure on the use of SYSADOAs as well as non-steroidal anti-inflammatory drugs (NSAIDs), which were unaffected by this policy change. We compared outpatient dispensations of SYSADOAs and NSAIDs from 2015 to 2017, measuring dispensed units, retail price, and out-of-pocket expenses for beneficiaries each month. After the change in coverage, there was a 61.6% total decrease in SYSADOA units dispensed, and a 63.4% decrease in the final sales price to the public, measured in constant values. Dispensation was not reoriented towards NSAIDs, which fell by 6.1%. The incidence of new treatments decreased (from 6.4 to 3.3 treatments per 1,000 beneficiaries per month), as did their continuity. Beneficiaries' out-of-pocket spending on SYSADOAs increased by 75.8% (at constant values). Disinvestment in interventions with questionable therapeutic value is an important tool in working toward the sustainability of health systems.

Hepatotoxicidad inducida por glucosamina-condroitina en un hospital público de Lima (Perú): reporte de caso / Case report of glucosamine-chondroitin induced hepatotoxicity in a public hospital in Lima, Peru

Resumen En el cuerpo humano tenemos glucosamina y condroitina de forma natural. Estas sustancias constituyen un componente importante del sistema cartilaginoso. Como medicamentos, tienen múltiples indicaciones clínicas, principalmente la osteoartritis. La hepatotoxicidad inducida por estas biomoléculas es infrecuente, pues cuentan solo con reportes de casos aislados en la literatura mundial. En este trabajo, presentamos el caso de una paciente con una lesión hepática inducida por glucosamina-condroitina del tipo hepatocelular, que fue admitida en el hospital por causa de una sintomatología respiratoria y malestar general. En ella, se destacó una marcada hipertransaminasemia durante los exámenes de laboratorio. Asimismo, se descartaron etiologías como el alcohol, hepatitis virales y hepatopatías autoinmunes, principalmente. De igual forma, no se llegó a evidenciar una enfermedad hepática crónica mediante la ecografía abdominal. Al suspenderse el medicamento, se observó una disminución considerable de la hipertransaminasemia luego de 1 semana, y una mejoría total de esta a los 2 meses del alta hospitalaria. Este caso se añade a los pocos reportados a nivel mundial y cobra una importancia relevante para la publicación de posteriores estudios sistemáticos que aclaren el panorama de esta enfermedad.

Abstract The human body naturally produces glucosamine and chondroitin which are important components of the cartilaginous system. There are multiple clinical indications for them as medicines, but they are primarily used for osteoarthritis. Hepatotoxicity induced by these biomolecules is uncommon, and the only reports in the world literature are isolated individual cases. This article presents the case of a patient with glucosamine-chondroitin-induced hepatocellular damage who was admitted to the hospital with respiratory symptoms and malaise. Marked hypertransaminemia was found in laboratory tests. Etiologies such as alcohol, viral hepatitis and autoimmune liver diseases were ruled out, and abdominal ultrasound found no evidence of chronic liver disease. Discontinuance of glucosamine and chondroitin led to a considerable decrease in hypertransaminemia after one week with total improvement two months of hospital discharge. This case adds to the small number reported worldwide and is relevant for future systematic studies to clarify the outlook for this disease.

Evaluation of Glucosamine Effect Against Heart and Brain Damage Induced by Y-radiation or Aluminium Chloride in Female Rats

Abstract Glucosamine is known as anti-inflammatory, antioxidant and as neuroprotective as well as using to treat many of diseases. This work aimed to investigate the remedial effect of glucosamine (20mg/kg b.wt) against the damage induced by a single dose of γ-radiation (8Gy) or aluminium chloride (AlCl3) (100mg/kg b.wt) in the heart and brain tissues of female rats. Serum aspartate aminotransferase (AST), cholesterol, triglycerides (TGs), LDH and creatine kinase (CPK) were measured. Moreover, gene expression of amyloid protein precursor (APP) and seladin-1 were estimated in the brain tissue. Also, acetylcholinesterase activity (AChE) and p-tau protein expression were estimated in brain homogenate. Metallothioneine (MT) was estimated in the heart and brain tissues. Heart and brain histopathological examination was performed. Irradiation significantly decreased serum AST, CPK and LDH, as well as MT levels in heart and brain tissues. Also, gene expression of seladin-1 decreased. On the other hand, irradiation significantly increased serum TGs level and brain AchE activity, tau protein, and β-amyloid percursor (APP). AlCl3 administration (21 days) induced disturbance in most of the estimated parameters, especially AST, TGs, and MT. Glucosamine treatment with irradiation or AlCl3 improved most of the measured parameters. In addition, histopathological examination confirmed the biochemical results. In conclusion: Glucosamine could be used to improve the heart and brain damages induced by γ-radiation exposure or AlCl3.

Therapeutic Effect of Glucosamine on an Atopic Dermatitis Animal Model

BACKGROUND: Recent studies have reported that glucosamine (GlcN) showed therapeutic effects in allergic diseases such as asthma and rhinitis, and its mechanisms include the suppression of T helper type 2 immune responses and the nuclear factor-κB pathway. OBJECTIVE: We aimed to investigate the effect of GlcN on atopic dermatitis (AD) in an animal model. METHODS: Twenty-five BALB/c mice were divided into five groups (groups A~E). Group A was the phosphate-buffered saline (PBS)-treated group without AD induction. Group B was the PBS control group with AD induction. Groups C to E were the AD induction groups, which were treated with three different doses of GlcN (10 mg, 20 mg, and 40 mg, respectively). Histopathological examination was performed after GlcN administration. Interleukin (IL)-4, IL-13, and IL-17 cytokine levels were measured by enzyme-linked immunosorbent assay using skin biopsy specimens. Serum total immunoglobulin E (IgE) concentrations were measured before and after administration with GlcN or PBS. RESULTS: Clinical dermatitis scores decreased with increasing GlcN dose (p<0.001). Concentrations of tissue IL-13 and IL-17 decreased after GlcN administration (each group: p=0.002 and p<0.001, respectively), but the concentrations of tissue IL-4 did not show differences across groups. Serum IgE levels tended to be lower after GlcN administration (p=0.004). Histopathological scores were not significantly different among groups B~E (p=0.394). CONCLUSION: GlcN improved AD symptoms and decreased tissue IL-13, IL-17, and serum total IgE levels in an animal model.

Protective effect of glucosamine and risedronate (alone or in combination) against osteoarthritic changes in rat experimental model of immobilized knee / 대한해부학회지

Generating evidence and understanding the treatment of osteoarthritis in Brazil: a study through Delphi methodology

OBJECTIVES: This study aimed to provide evidence for understanding how to treat osteoarthritis (OA) in our country. Therefore, it was necessary to match information and investigations related to the treatment of the disease from the three main types of specialists involved: physiatrists, orthopedists and rheumatologists. METHODS: The authors acted as a scientific advisory committee. From the initial discussions, a structured questionnaire was developed for use with a group of specialists on OA using the Delphi technique. The questionnaire was sent to 21 experts appointed by the authors, and the results obtained were critically analyzed and validated. RESULTS: The prevalence of OA was 33% in Brazil, corresponding to one-third of the individuals in the reference population, which included individuals over 25 years of age. Another significant finding was that most patients did not receive any form of treatment in the early stages of OA. CONCLUSION: The committee pointed to the need for early intervention and that the available medicinal resources can fulfil this important role, as is the case with SYSADOA treatments. Glucosamine-based medicinal products with or without chondroitin could also fulfill this need for early treatment. The other generated evidence and included investigations were then grouped together and are the subject of this publication.

Roles of Health Technology Assessment for Better Health and Universal Health Coverage in Korea / 보건행정학회지

Health technology assessment (HTA) is defined as multidisciplinary policy analysis to look into the medical, economic, social, and ethical implications of the development, distribution, and use of health technology. Following the recent changes in the social environment, there are increasing needs to improve Korea's healthcare environment by, inter alia, assessing health technologies in an organized, timely manner in accordance with the government's strategies to ensure that citizens' medical expenses are kept at a stable level. Dedicated to HTA and research, the National Evidence-based Healthcare Collaborating Agency (NECA) analyzes and provides grounds on the clinical safety, efficacy, and economic feasibility of health technologies. HTA offers the most suitable grounds for decision making not only by healthcare professionals but also by policy makers and citizens as seen in a case in 2009 where research revealed that glucosamine lacked preventive and treatment effects for osteoarthritis and glucosamine was subsequently excluded from the National Health Insurance's benefit list to stop the insurance scheme from suffering financial losses and citizens from paying unnecessary medical expenses. For the development of HTA in Korea, the NECA will continue exerting itself to accomplish its mission of providing policy support by health technology reassessment, promoting the establishment and use of big data and HTA platforms for public interest, and developing a new value-based HTA system.

The therapeutic effects of Yougui pill on knee osteoarthritis and the expression of Wnt signal pathway related factors in rats / 中国应用生理学杂志

OBJECTIVES@#To observe the effects of Yougui pill (Traditional Chinese Medicine) on the related factors of Wnt signal pathway of rats with knee osteoarthritis (KOA), and explore its protective mechanism.@*METHODS@#Sixty SPF SD rats were randomly divided into the sham-operative group, model group, glucosamine sulfate group, high-dose, middle-dose, low-dose of Yougui pill treated group (=10). KOA model was established by modified Hulth method for six weeks. The rats in the high, middle and low-dose of Yougui pill group were treated with Yougui pills at the doses of 20,10 and 5 g/kg respectively by gastrogavage once a day for 8 weeks, while equal volume of normal saline was given to those in the sham and model control group and an equal volume of glucosamine sulfate (1.7 g/kg·d) was given to those in glucosamine sulfate group for 8 weeks. The knee joint was removed after the last dose of drug. The pathological changes of cartilaginous tissues were observed under a microscope. The mRNA levels of Dickkopf homolog 1(DKK1), Wnt induced secreted protein 1(WISP1), Wnt1, low density lipoprotein receptor related protein 5(LRP5) and beta -catenin in rats cartilaginous tissues were analyzed by using RT-PCR method, and the protein contents of DKK1, WISP1, Wnt1, LRP5 and beta-catenin in cartilaginous tissues were detected by Western blot.@*RESULTS@#Compared with the sham group, the articular cartilage was severely damaged, the Mankin score was increased significantly (<0. 05), the mRNA and protein expression levels of DKK1 in cartilaginous tissue were markedly decreased(<0.05), while those of WISP, Wnt1, LRP5 and beta-catenin were increased significantly in model group(<0.05). Compared with model group, the articular cartilage lesions was light (<0.05), the Mankin Score was decreased significantly(<0.05), and the mRNA and protein levels of DKK1 in cartilaginous tissue were increased(<0.05), while those of WISP, Wnt1, LRP5 and beta-catenin were decreased in Yougui pill high-dose group and glucosamine sulfate group (<0.05).@*CONCLUSIONS@#Yougui pill has protective effects on the KOA by inhibiting the expressions of WISP, Wnt1, LRP5, beta-catenin and increasing the expression of DKK1 cytokine in the Wnt signaling pathway.

Glucosamine Hydrochloride and N-Acetylglucosamine Influence the Response of Bovine Chondrocytes to TGF-β3 and IGF in Monolayer and Three-Dimensional Tissue Culture

BACKGROUND: Glucosamine hydrochloride (GlcN·HCl) has been shown to inhibit cell growth and matrix synthesis, but not with N-acetyl-glucosamine (GlcNAc) supplementation. This effect might be related to an inhibition of critical growth factors (GF), or to a different metabolization of the two glucosamine derivatives. The aim of the present study was to evaluate the synergy between GlcN·HCl, GlcNAc, and GF on proliferation and cartilage matrix synthesis. METHOD: Bovine chondrocytes were cultivated in monolayers for 48 h and in three-dimensional (3D) chitosan scaffolds for 30 days in perfusion bioreactors. Serum-free (SF) medium was supplemented with either growth factors (GF) TGF-β (5 ng mL₋₁) and IGF-I (10 ng mL₋₁), GlcN·HCl or GlcNAc at 1mM each or both. Six groups were compared according to medium supplementation: (a) SF control; (b) SF + GlcN·HCl; (c) SF + GlcNAc; (d) SF + GF; (e) SF + GF + GlcN·HCl; and (f) SF + GF + GlcNAc. Cell proliferation, proteoglycan, collagen I (COL1), and collagen II (COL2) synthesis were evaluated. RESULTS: The two glucosamines showed opposite effects in monolayer culture: GlcN·HCl significantly reduced proliferation and GlcNAc significantly augmented cellular metabolism. In the 30 days 3D culture, the GlcN·HCl added to GF stimulated cell proliferation more than when compared to GF only, but the proteoglycan synthesis was smaller than GF. However, GlcNAc added to GF improved the cell proliferation and proteoglycan synthesis more than when compared to GF and GF/GlcN·HCl. The synthesis of COL1 and COL2 was observed in all groups containing GF. CONCLUSION: GlcN·HCl and GlcNAc increased cell growth and stimulated COL2 synthesis in long-time 3D culture. However, only GlcNAc added to GF improved proteoglycan synthesis.

Effects of fermentation conditions on valuable products of ethanolic fungus Mucor indicus

Background: Mucor indicus is a dimorphic fungus used in the production of ethanol, oil, protein, and glucosamine. It can ferment different pentoses and hexoses; however, the yields of products highly depend on the nutrients and cultivation conditions. In this study, the effects of different morphologic forms, cultivation time and temperature, presence or absence of oxygen, carbon sources, and concentration of nitrogen source on the products of M. indicus were investigated. Results: The fungus with all morphologies produced high yields of ethanol, in the range of 0.32­0.43 g/g, on glucose. However, the fungus with filamentous morphology produced higher amounts of oil, protein, phosphate, and glucosamine together with ethanol, compared with other morphologies. A higher amount of oil (0.145 g/g biomass) was produced at 28°C, while the best temperature for protein and glucosamine production was 32 and 37°C, respectively. Although ethanol was produced at a higher yield (0.44 g/g) under anaerobic conditions compared with aerobic conditions (yield of 0.41 g/g), aerobic cultivation resulted in higher yields of protein (0.51 g/g biomass), glucosamine (0.16 g/g alkali insoluble material, AIM), and phosphate (0.11 g/g AIM). Conclusions: It is not possible to have the maximum amounts of the products simultaneously. The fermentation conditions and composition of culture media determine the product yields. Carbon source type and the addition of nitrogen source are among the most influencing factors on the product yields. Moreover, all measured products were made with higher yields in cultivation on glucose, except glucosamine, which was produced with higher yields on xylose.

Análisis de costo-efectividad del condroitín más glucosamina comparado con acetaminofén, AINEs y celecoxib para el tratamiento sintomático de adultos con osteoartrosis de rodilla y mano en Colombia / Cost-effectiveness analysis of chondroitin plus glucosamine compared to acetaminophen, AINEs and celecoxib for the symptomatic treatment of adults with knee and hand osteoarthrosis in Colombia

Problema de investigación: Analizar los costos y la efectividad del condroitín más glucosamina, cetaminofén, celecoxib y AINEs para pacientes mayores de 50 años con osteoartrosis sintomática (primaria y secundaria) en Colombia. Tipo de evaluación económica: Análisis de costo-efectividad. Población objetivo: Personas mayores de 50 años de edad (hombres y mujeres) con osteoartrosis sintomática (primaria y secundaria) en Colombia. intervención y comparadores: I: condroitín más glucosamina, C: acetaminofén, celecoxib y AINEs. Horizonte temporal: Se empleó como horizonte temporal la expectativa de vida promedio de los pacientes con OA mayores a 50 años en Colombia. Puesto que la expectativa de vida promedio en Colombia es de 74 años para la población general (hombres y mujeres), se utilizó un horizonte de tiempo del modelo de 24 años con base en las estadísticas vitales del DANE. Perspectiva: La del Sistema General de Seguridad Social en Salud (SGSSS). Tasa de descuento: Tanto los costos como los beneficios son descontados al valor presente, utilizando una tasa de descuento del 5%. Estructura del modelo: Se estructuró un modelo Markov reflejando el curso clínico de la enfermedad con ciclos anuales. Fuentes de datos de efectividad y seguridad: Revisión de ensayos clínicos, meta-análisis y literatura clínica para la obtención de los parámetros para la modelación dinámica de la osteoartrosis sintomática en Colombia, y para la determinación de la efectividad de las alternativas de comparación. Desenlaces y valoración: Años de vida ganados. Costos incluidos: Costo de medicamentos para el tratamiento, Costo relacionados al manejo de eventos adversos, Costo de procedimientos e insumos. Fuentes de datos de costos: SISMED, Manual tarifario ISS 2001, Guía de práctica clínica para el síndrome coronario agudo. Resultados del caso base: El costo esperado por año de vida ajustado por calidad ganado de condroitín más glucosamina fue de $ 4.218.759,75 por persona, de $5.694.205,75 con AINEs, de $3.312.855,30 con celecoxib y de $2.616.444,62 con acetaminofén. El acetaminofén resultó en el mayor número de años de vida ajustados por calidad ganados (6,917). Estos resultados implican que el acetaminofén sería costo-efectivo y que es una estrategia dominante respecto a sus comparadores. Análisis de sensibilidad: Los análisis de sensibilidad llevados a cabo sobre la tasa de descuento y las variables con mayor impacto sobre la RICE evidencian que ninguno de estos parámetros \r\nmodifica los resultados encontrados. La dominancia del acetaminofén es consistente ante los escenarios \r\nplanteados. Adicionalmente, con el umbral establecido de mínimo un PIB y máximo tres PIB per cápita, se observa que el acetaminofén tiene una probabilidad de cerca de 100% de ser más costo-efectivo que los otros medicamentos incluidos en este estudio. Conclusiones: En Colombia, desde la perspectiva del sistema general de seguridad social en salud, la terapia combinada de condroitín más glucosamina para el tratamiento sintomático de pacientes mayores de 50 años de edad con osteoartrosis de rodilla o mano, es una tecnología dominada, indicando que no sería una alternativa costo-efectiva para el país. Entre las opciones evaluadas, el acetaminofén es la tecnología con mejor costo-efectividad, pues se asocia con costos más bajos y un incremento en años de vida ajustados por calidad.(AU)

Análisis de impacto presupuestal de condroitín más glucosamina comparado con acetaminofén, AINES y celecoxib para osteoartrosis sintomática (primaria y secundaria) de la rodilla en Colombia / Analysis of budgetary impact of chondroitin plus glucosamine compared to acetaminophen, AINES and celecoxib for symptomatic (primary and secondary) osteoarthritis of the knee in Colombia

Tecnologías evaluadas: Nuevas: condroitín más glucosamina y AINES (celecoxib y meloxicam) Actuales: acetaminofén y AINES (ibuprofeno, naproxeno y diclofenaco). Población: Pacientes mayores de 50 años con osteoartrosis sintomática (primaria y secundaria) en Colombia. Perspectiva: La perspectiva del presente AIP corresponde al tercero pagador, que en este caso es el Sistema General de Seguridad Social en Salud (SGSSS) en Colombia. Horizonte temporal: El horizonte temporal de este AIP en el caso base corresponde a un año. Adicionalmente se reportan las estimaciones del impacto presupuestal para los años 2 y 3, bajo el supuesto de la inclusión en el POS en el año 1. Costos incluidos: Costos por mg de los medicamentos analizados y costos de eventos adversos relacionados al uso de los medicamentos. Fuente de costos: Los precios de cada tecnología considerada fueron calculados con la base de datos SISMED 2014 y los precios relacionados con los eventos adversos fueron extraídos de la guía de práctica clínica para el síndrome coronario agudo. Escenarios: En el escenario 1 se considera que la adopción de las nuevas tecnologías no llevaría a ningún cambio en el mercado, debido a la fuerte preferencia de los médicos para el uso de las tecnologías actuales. En el escenario 2 se asume que la adopción de las nuevas tecnologías resultará en una disminución en el costo de dichas tecnologías, implicando un pequeño aumento en su participación de mercado. Resultados: Se requeriría una inversión de $324.848.741.965,21 para el año 1, $408.850.393.031,63 para el año 2 y $516.306.727.474,66 para el año 3 para la adopción de las terapias condroitín más glucosamina, meloxicam y celecoxib en el POS para el tratamiento de pacientes con osteoartrosis sintomática (primaria y secundaria) de la rodilla en Colombia, bajo el presupuesto que la inclusión de los nuevos medicamentos no llevaría a un cambio en la participación del mercado. Asumiendo que el precio de las nuevas terapias disminuyera y por tal razón la participación del mercado de dichas terapias aumentaría,\tel impacto presupuestal aumentaría a \r\n$33.328.838.947,92 en el año 1, de $44.301.385.949,68 en el año 2 y de $59.253.690.046,56 en el año 3.(AU)

Effects of gangliosides from deer bone extract on the gene expressions of matrix metalloproteinases and collagen type II in interleukin-1β-induced osteoarthritic chondrocytes

BACKGROUND/OBJECTIVES: We investigated the anti-osteoarthritic effects of deer bone extract on the gene expressions of matrix metalloproteinases (MMPs) and collagen type II (COL2) in interleukin-1β-induced osteoarthritis (OA) chondrocytes. MATERIALS/METHODS: Primary rabbit chondrocytes were treated as follows: CON (PBS treatment), NC (IL-1β treatment), PC (IL-1β + 100 µg/mL glucosamine sulphate/chondroitin sulphate mixture), and DB (IL-1β + 100 µg/mL deer bone extract). RESULTS: The results of the cell viability assay indicated that deer bone extract at doses ranging from 100 to 500 µg/mL inhibits cell death in chondrocytes induced by IL-1β. Deer bone extract was able to significantly recover the mRNA expression of COL2 that was down-regulated by IL-1β (NC: 0.79 vs. DB: 0.87, P < 0.05) and significantly decrease the mRNA expression of MMP-3 (NC: 2.24 vs. DB: 1.75) and -13 (NC: 1.28 vs. DB: 0.89) in OA chondrocytes (P < 0.05). CONCLUSIONS: We concluded that deer bone extract induces accumulation of COL2 through the down-regulation of MMPs in IL-1β-induced OA chondrocytes. Our results suggest that deer bone extract, which contains various components related to OA, including chondroitin sulphate, may possess anti-osteoarthritic properties and be of value in inhibiting the pathogenesis of OA.

Análise das propriedades físico-químicas da glucosamina sulfato comercial, uma matéria- prima utilizada em formulações farmacêuticas / Physicochemical properties analysis of commercial glucosamine sulfate, a raw material used in pharmaceutical formulations

Introdução: A qualidade dos produtos em farmácias de manipulação é determinada pela Agência Nacional de Vigilância Sanitária (ANVISA), mas os métodos descritos podem não ser adequados para analisar seus aspectos físico-químicos. Objetivo: Comparar aspectos físico-químicos da glucosamina sulfato de dois diferentes fornecedores com análises realizadas na farmácia de manipulação. Métodos: As características organolépticas, pH, solubilidade e densidade da glucosamina (n=50) dos fornecedores foram analisadas conforme descrito na Farmacopeia Brasileira e Compêndio Oficial e comparados aos laudos técnicos dos produtos adquiridos. Usaram-se os testes de Kolmogorov-Smirnov, coeficiente de correlação intraclasse (CCI) e Bland-Altman. Resultados: A análise de CCIevidenciou baixa reprodutibilidade para o teste de pH e densidade, e a análise de Bland-Altman demonstrou que os fornecedores subestimavam ou superestimavam os valores de pH e densidade em relação à farmácia. Conclusão: Os aspectos físico-químicos estão adequados conforme orientações da Anvisa, mas novas técnicas mais sensíveis devem ser utilizadas para garantir a qualidade da glucosamina nas formulações.

Introduction: The raw materials quality in the manipulation pharmacies are determined by Brazilian Health Surveillance Agency (ANVISA), but the protocols described may not be appropriate to analyze their physicochemical properties. Objective: To compare the physicochemical properties of glucosamine sulfate from two different suppliers with results obtained in the manipulation pharmacy. Methods: The organoleptic characteristics, pH, solubility and density of glucosamine samples (n=50) were analyzed according to the Brazilian Pharmacopoeia and Official Compendium and compared the technical reports of the suppliers. The results were analyzed by the Kolmogorov-Smirnov test, intraclass correlation coefficient (CCI) and Bland-Altman. Results: CCI analyses showed low reproducibility for pH and density test in the samples tested. In addition, Bland-Altman analysis indicated pH values and density of suppliers were underestimated or overestimated compared to the pharmacy. Conclusion: Physicochemical properties of glucosamine are appropriate according to Anvisa specifications, but new more sensitive techniques should be employed to ensure the glucosamine quality in the formulations.

Chondroitin sulfate and glucosamine in the cartilage and subchondral bone repair of dogs - Histological findings / Sulfato de condroitina e glucosamina na reparação da cartilagem e do osso subcondral de cães - Achados histológicos

Chondroitin and glucosamine sulfate nutraceuticals are commonly used in the management of degenerative articular disease in veterinary routine. However, there are controversies on the contribution of these substances to articular cartilage. The purpose of this study was to evaluate the efficiency of a chondroitin and glucosamine sulfate-based veterinary nutraceutical on the repair of an induced osteochondral defect in a dog femoral condyle, by macroscopic, histological and histomorphometric analyses. The nutraceutical was orally administered the day following injury induction, every 24 hours (treated group, TG, n=24), compared with animals that did not receive the product (control group, CG, n=24). Six animals per group were anaesthetized for sample collection at 15, 30, 60 and 90 days after surgery. At 15 days, defects were macroscopically filled with red-pinkish tissue. After 30 days, whitish color tissue was observed, both in TG and CG animals, with firmer consistency to touch at 60 and 90 postoperative days. Histological analysis demonstrated that, in both groups, there was initial blood clot formation, which was subsequently substituted by a fibrin net, with capillary proliferation from the adjacent bone marrow and infiltration of mesenchymal cells in clot periphery. As cellular differentiation developed, repair tissue presented a fibrocartilage aspect most of the time, and new subchondral bone formation occurred in the deepest area corresponding to the defect. Histomorphometry suggested that the nutraceutical did not favor the articular cartilage repair process. It was concluded that nutraceutical did not significantly influence chondrocytes proliferation or hyaline architecture restoration.(AU)

Os nutracêuticos compostos de sulfato de condroitina e glucosamina são comumente utilizados no manejo da doença articular degenerativa na rotina veterinária. Entretanto, existem controvérsias sobre a contribuição dessas substâncias à cartilagem articular. O objetivo deste trabalho foi avaliar a eficácia de um nutracêutico veterinário à base de sulfato de condroitina e glucosamina na reparação de defeitos osteocondrais induzidos no côndilo femoral de cães, através de análises macroscópica, histológica e histomorfométrica. O nutracêutico foi administrado no dia seguinte à indução da lesão, pela via oral, a cada 24 horas (grupo tratado - GT, 24 animais), sendo comparado a animais que não receberam o produto (grupo controle - GC, de igual número de animais). Aos 15, 30, 60 e 90 dias após a cirurgia, seis animais por grupo foram anestesiados para ser realizada a coleta das amostras. Aos 15 dias, os defeitos eram macroscopicamente preenchidos por tecido de coloração rósea a avermelhada. Já a partir dos 30 dias, observou-se preenchimento por tecido de coloração esbranquiçada, tanto nos animais do GT quanto nos do GC, com consistência mais firme ao toque digital aos 60 e 90 dias de pós-operatório. A análise histológica revelou que, em ambos os grupos, houve inicialmente formação de coágulo sanguíneo que, posteriormente, foi substituído por uma rede de fibrina, com proliferação de capilares a partir da medula óssea adjacente e infiltração de células mesenquimais na periferia do coágulo. À medida que se processou a diferenciação celular, o tecido de reparação se apresentou na maioria das vezes com aspecto de fibrocartilagem e, na região mais profunda da área correspondente ao defeito, ocorreu formação de osso novo subcondral. A histomorfometria sugeriu que o nutracêutico não favoreceu o processo de reparação da cartilagem articular. Concluiu-se que o nutracêutico não influenciou consideravelmente na proliferação de condrócitos nem na restauração da arquitetura hialina.(AU)

A Flood of Health Functional Foods: What Is to Be Recommended?

Health functional food is referred to a food prepared or processed from specific components or ingredients for functionality beneficial to the body through extraction, concentration, purification, blending and other methods. The demand for health functional foods is steadily increasing, and red ginseng is the most demanded food among women in the 50s, followed by multivitamin, omega-3, glucosamine and aloe. To date, there is insufficient evidence on the effect of red ginseng on exercise capacity, somatic symptom and cognitive performance in healthy individuals. Moreover, evidence is insufficient that a nutritional dose of vitamin or mineral reduces the incidence of cardiovascular disease and cancer, or mortality rate. A steady intake of oily fish is recommended to prevent the incidence of cardiovascular disease for postmenopausal women. Consumption of omega-3 fatty acids is expected to prevent cardiovascular disease in postmenopausal women with almost no intake of oily fish and those not taking statins. It still remains controversial whether glucosamine is effective in the treatment of osteoarthritis. Hence, physicians should fully inform patients with all controversial information about the effectiveness of glucosamine when prescribing glucosamine for patients with osteoarthritis.