1942 - The Joints On Glucosamine (JOG) Study: A Randomized, Double-Blind, Placebo-Controlled Trial to Assess the Structural Benefit of Glucosamine in Knee Osteoarthritis Based On 3T MRI

Tuesday, October 20, 2009: 5:00 PM
108 B (Pennsylvania Convention Center)
C. Kent Kwoh1, Frank W. Roemer2, Michael J. Hannon3, Carolyn E. Moore4, John M. Jakicic3, Ali Guermazi2, Stephanie M. Green3 and Robert M. Boudreau3, 1University of Pittsburgh, VA Pittsburgh Healthcare System, Pittsburgh, PA, 2Boston University School of Medicine, Boston, MA, 3University of Pittsburgh, Pittsburgh, PA, 4Texas Woman's University, Houston, TX
Presentation Number: 1942

Purpose: Prior studies of the structural benefit of glucosamine in knee osteoarthritis (KOA) as assessed by radiographs have yielded conflicting results.  The aim of this study was to determine the short-term efficacy of glucosamine based on decreased worsening of  structural lesions in KOA as assessed using 3T MRI.

Method: The Joints on Glucosamine (JOG) study was a 24-week double-blind placebo controlled trial of 1500 mg glucosamine hydrochloride once daily in beverage form compared to placebo. The primary outcome was decreased development of cartilage damage. Eligible participants had mild to moderate knee pain (WOMAC score > = 125). 3T MRI of both knees was performed at baseline and at 24 weeks on a Siemens Trio using the same pulse sequences used in the Osteoarthritis Initiative (OAI): sagittal fat-suppressed (FS) 2D TSE intermediate-weighted (IW); sagittal 3D dual-echo steady state (DESS) WE; and axial and coronal reformations of sagittal 3D DESS WE. Cartilage damage, bone marrow lesions (BMLs) and synovitis in each knee were scored according to the WORMS system. Baseline fixed-flexion knee x-rays were read for Kellgren-Lawrence (K-L) grade and radiographic features such as joint space narrowing using the OARSI grading system. All MRIs and x-rays were read masked to treatment assignment but not to baseline vs. follow-up order. Urinary excretion of C-terminal cross linking telopeptide of type II collagen (uCTX-II) as a biomarker of cartilage synthesis was also assessed. An Intent-to-Treat analysis with last event carried forward was performed. Negative binomial regression for cartilage defects and multivariate logistic regression for worsening BML, taking into account clustering of knees within an individual and adjusted for gender, age, BMI, baseline WOMAC, and K-L grade, were performed to determine the odds (aOR) of worsening based on treatment group assignment.  These covariates were used in a linear regression model for uCTX-II.

Results: There were a total of 201 participants (49% women) with a mean age of 52, 98 were block randomized to the treatment group and 103 to the control group. The aOR of worsening cartilage defects in the glucosamine group compared to the control group was 0.9 (95% CI 0.55-1.58). The aOR for worsening in BMLs was 0.73 (95% CI 0.50-1.07).

There also was no indication that glucosamine improved uCTX-II (beta = -0.10, 95% CI -0.21-.001). There was a difference in the proportion of drop-outs by group (i.e., 16.5% in the placebo group vs. 5.1% from the glucosamine group, p < 0.01).

Conclusion: This short-term study provided no evidence that glucosamine results in structural benefit in knee OA as assessed using 3T MRI or uCTX.

Keywords: glucosamine, magnetic resonance imaging (MRI) and osteoarthritis

Disclosure: C. K. Kwoh, The Beverage Institute, 2 ; F. W. Roemer, Boston Imaging Core Lab, LLC, 4 ; M. J. Hannon, None; C. E. Moore, None; J. M. Jakicic, The Beverage Institute, 2, The Beverage Institute, 5 ; A. Guermazi, Synarc, Inc., 1, Boston Imaging Core Lab, LLC, 4, MerckSerono; Facet Solutions , 5, GE HealthCare, 2 ; S. M. Green, None; R. M. Boudreau, None.