Effectiveness of Combined Glucosamine and Chondroitin Sulfate Therapy in Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
A.A. Budko, L.A. Akulkina, E.E. Fedorinova, T.K. Berzegova, V.B. Matysik
Background. Glucosamine and chondroitin sulfate are widely used symptomatic slow-acting drugs for osteoarthritis; however, their efficacy remains controversial.
Objective: to evaluate the efficacy of combined glucosamine and chondroitin sulfate therapy in knee osteoarthritis through a systematic review and meta-analysis of randomized controlled trials.
Materials and methods. A systematic search of Medline, EMBASE, Cochrane Library, and PubMed databases was conducted covering 2000–2024. Eligible studies were randomized controlled trials of duration ≥8 weeks comparing glucosamine and/or chondroitin sulfate with placebo in symptomatic knee osteoarthritis. Quality was assessed with Cochrane RoB 2.0 and Newcastle–Ottawa tools. Random-effects meta-analysis (DerSimonian–Laird method) was used to calculate pooled standardized mean differences (SMD) with 95% confidence intervals.
Results. Seventeen studies (n = 6,198) were included. The mean age of participants was 60.5 ± 10.1 years; 68.6% were women. The mean treatment duration was 34.7 ± 33.3 weeks. Combined therapy was associated with statistically significant improvements versus placebo in visual analogue scale pain (SMD -0.180; 95% CI: from -0.271 to -0.089; p < 0.001; I² = 81.7%) and WOMAC function (SMD -0.170; 95% CI: from -0.254 to -0.086; p < 0.001; I² = 78.1%). The safety profile was similar to placebo. Egger’s test did not detect publication bias (p >0.10).
Conclusion. Combined glucosamine and chondroitin sulfate therapy provides statistically significant but clinically small improvements in pain and function for knee osteoarthritis. The effect size is small (SMD <0.2) but may be clinically relevant for selected patients given the favorable safety profile.
For citation: Budko AA, Akulkina LA, Fedorinova EE, Berzegova TK, Matysik VB. Effectiveness of combined glucosamine and chondroitin sulfate therapy in knee osteoarthritis: A systematic review and meta-analysis of randomized controlled trials. Therapy (Moscow). 2026;12(5S):94–103.
https://doi.org/10.18565/therapy.2026.5-s5.94-103
Ключевые слова
knee osteoarthritis
glucosamine
chondroitin sulfate
meta-analysis
symptomatic slow-acting drugs for osteoarthritis
effectiveness
combined therapy
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Об авторах / Для корреспонденции
Anton A. Budko, MD, postgraduate student of the Department of internal diseases of the Faculty of fundamental medicine, Medical Research and Educational Institute of Lomonosov Moscow State University; doctor at the University Clinical Hospital No. 3, Sechenov First Moscow State Medical University, Moscow, Russian Federation.E-mail: anton-budko@mail.ru
ORCID: https://orcid.org/0000-0002-7362-176Х
Larisa A. Akulkina, MD, PhD (Medicine), pulmonologist at the University Clinical Hospital No. 3, assistant at the Department of internal and occupational diseases and rheumatology of the Institute of Clinical Medicine, Sechenov First Moscow State Medical University, Moscow, Russian Federation.
E-mail: akullar.ru@mail.ru
ORCID: https://orcid.org/0000-0002-4307-8882
Ekaterina E. Fedorinova, MD, PhD (Medicine), rheumatologist at the University Clinical Hospital No. 3, assistant at the Department of internal and occupational diseases and rheumatology of the Institute of Clinical Medicine, Sechenov First Moscow State Medical University, Moscow, Russian Federation.
E-mail: filatevichk@gmail.com
ORCID: https://orcid.org/0000-0003-0853-8967
Tamara K. Berzegova, MD, rheumatologist at Ekaterininskaya Clinic LLC, Krasnodar, Russian Federation.
E-mail: tberzegova@gmail.com
ORCID: https://orcid.org/0009-0006-1548-5903
Victoria B. Matysik, MD, rheumatologist at Medilux-TM LLC; rheumatologist at the Consultative and Diagnostic Department of the Clinical Medical Center, Russian University of Medicine, Moscow, Russian Federation.
E-mail: nadtocheeva.vicka@yandex.ru
ORCID: https://orcid.org/0000-0002-7402-5222
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