Knee and Hip Osteoarthritis: Efficacy and Safety of Disease-Modifying Drugs

Pavankumar Kamat.


April 21, 2021


  • In patients with knee and hip osteoarthritis (OA), glucosamine and chondroitin demonstrated marginal small yet significant structural and symptomatic effects, in addition to favourable safety.

  • Strontium showed therapeutic benefit in terms of structure modification and vitamin D improved symptoms.

  • Doxycycline demonstrated a promising efficacy ranking, but has a poor safety profile.

Why this matters

  • Findings could help physicians, patients, and researchers in making informed decisions regarding the use of disease-modifying OA drugs (DMOADs) in treatment, clinical studies, and basic research into OA.

Study design

  • UK researchers performed a network meta-analysis of 28 randomised controlled trials (n=11,890) assessing 12 classes of DMOADs with ≤12 months of follow-up.

  • Funding: None disclosed.

Key results

  • Glucosamine and chondroitin marginally improved (standardised mean difference [SMD]; 95% CI:

    • minimum joint width or cartilage volume:

      • glucosamine (0.16; 0.04-0.28); and

      • chondroitin (0.21; 0.10-0.32).

    • pain:

      • glucosamine (-0.15; -0.25 to -0.05;); and

      • chondroitin (-0.06; -0.15 to 0.03).

    • function:

      • glucosamine (-0.17; -0.28 to -0.07); and

      • chondroitin (-0.15; -0.26 to -0.03;).

  • Strontium was associated with an improvement in minimum joint width or cartilage volume (SMD, 0.20; 95% CI, 0.02-0.38).

  • Vitamin D showed improvement in:

    • pain (SMD, -0.15; 95% CI, -0.27 to -0.03); and

    • function (SMD, -0.18; 95% CI, -0.31 to -0.06;).

  • Doxycycline demonstrated favourable efficacy in terms of structure and function, but its safety profile was poor (withdrawal because of adverse events: relative risk, 1.69; 95% CI, 1.03-2.75).


  • None of the individual trials provided outcome data stratified by OA stage.


Yang W, Sun C, He SQ, Chen JY, Wang Y, Zhuo Q. The Efficacy and Safety of Disease-Modifying Osteoarthritis Drugs for Knee and Hip Osteoarthritis-a Systematic Review and Network Meta-Analysis. J Gen Intern Med. 2021 Apr 12 [Epub ahead of print]. doi: 10.1007/s11606-021-06755-z. PMID: 33846938. View abstract 

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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