ISRCTN ISRCTN14885594
DOI https://doi.org/10.1186/ISRCTN14885594
Secondary identifying numbers 104/C.E. of 4th February 2013
Submission date
10/12/2014
Registration date
04/02/2015
Last edited
04/02/2015
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Musculoskeletal Diseases
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data
Record updated in last year

Plain English summary of protocol

Background and study aims
Osteoarthritis (OA) is the most common disease affecting the joint. It can develop in any joint but it most often affects those that carry weight, such as the hips, spine and knees. It is caused by damage in and around the joint that can’t be fully repaired. Some of the cartilage (the protective layer covering the bones at the joint that ensures the joint moves smoothly) can become damaged or lost, leading to swelling (inflammation), pain and stiffness. Typical symptoms also include a deep, aching pain which can spread (radiate) from the affected joint, loss in the range of movement possible in the joint and the development of hard, bony, growths. Sufferers may also feel like their joints are crunching or grinding when they use them and find that they give way when weight is put on them. It is a long-term condition that can get worse over time. Treatment options include regular (sometimes prescribed) exercise, losing excess weight, drug treatments (such as painkillers and anti-inflammatories) and surgery. Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used to control OA symptoms. However, they are associated with a range of gastro-intestinal and cardiovascular side effects and other adverse effects on health. Due to safety concerns when taking these drugs, patients have turned to dietary supplements that claim to be beneficial in treating OA and safer than NSAIDS. This includes glucosamine sulfate (GS). Studies using GS to treat OA have suggested that this supplement can help protect joints against damage and repair damage that has been done. Glucosamine scored the highest level of evidence and strength of recommendation for knee OA symptoms in the current European League Against Rheumatism (EULAR) practice guidelines, and it is recommended by the latest Osteoarthritis Research Society International (OARSI) guidelines as a result. Other supplements that may help manage OA symptoms include methylsulfonylmethane (MSM) and boswellia acids (BA), both of which have been examined in previous studies. Here, we want to compare the benefits of taking MSM and BA with GS in mild to moderate knee OA.

Who can participate?
Adults aged between 25 and 85 years of age with OA of the knee.

What does the study involve?
Participants are randomly allocated into one of two groups. Those in group 1 (MB group) receive MSM and BA. Those in group 2 (GS group) are given GS supplements. All participants are asked to stop taking any anti-inflammatory drugs for at least 7 days before starting to take the supplements. They all undergo a clinical assessment and medical history at the time they start the treatment and then at two follow up visits, one 2 months after the treatment begins and the other after 6 months. Any participants that experience pain are allowed to take paracetamol, pyroxicam or diclofenac. Participants are also asked to write down their anti-flammatory drug use in a diary for evaluation purposes.

What are the possible benefits and risks of participating?
Both supplements are safe. Adverse effects are gastric heaviness or diarrhea.

Where is the study run from?
1. General Hospital of Bari (Italy)
2. Policlinico di Bari (Italy)

When is the study starting and how long is it expected to run for?
February 2012 to December 2014

Who is funding the study?
Laborest Spa (Italy)

Who is the main contact?
1. Professor Biagio Moretti
biagio.moretti@uniba.it
2. Dr Angela Notarnicola
angelanotarnicola@yahoo.it

Contact information

Professor Biagio Moretti
Public

Piazza g.cesare 11
Bari
70124
Italy

Phone +39 (0)805592938
Email biagio.moretti@uniba.it
Dr Angela Notarnicola
Scientific

Piazza g.cesare 11
Bari
70124
Italy

Phone +39 (0)805592938
Email angelanotarnicola@yahoo.it

Study information

Study designProspective, randomized controlled trial.
Primary study designInterventional
Secondary study designRandomised controlled trial
Study setting(s)Hospital
Study typeTreatment
Participant information sheet Not available in web format, please use the contact details below to request a participant information sheet
Scientific titleComparative Effectiveness of Methylsulfonylmethane and Boswellic Acids versus Glucosamine Sulfate in the Treatment of Mild to Moderate Knee Arthritis
Study acronymMEBAGA
Study objectivesThe aim of the present investigation is to better characterize the symptomatic activity of Methylsulfonylmethane (MSM) and Boswellic Acids (BA) in patients with OA of the knee, in comparison with the commonly prescribed Glucosamine Sulfate (GS).
Ethics approval(s)Ethics Committee of General Hospital of Bari, Italy, 04/02/2013, ref. n.104/C.E.
Health condition(s) or problem(s) studiedThe required study population was patients affected by gonarthrosis
InterventionPatients were randomized into two groups; the first taking the MSM and BA (MB group) and second the GS (GS group).
Intervention typeSupplement
Primary outcome measureResponse to treatment, defined as a decrease of pain on the VAS and an improvement in the patient’s global assessment score on the LEQUESNE INDEX from baseline at 2 and at 6 months.
Secondary outcome measuresReduction in the patients’ need to take anti-inflammatory drugs at 2 and 6 months. All analyses were performed at each FU, comparing results within each group and between the two groups.
Overall study start date01/02/2012
Completion date01/12/2014

Eligibility

Participant type(s)Patient
Age groupAdult
SexBoth
Target number of participants200
Key inclusion criteria1. Men and women >25 and <86 years of age
2. A diagnosis of OA of the knee according to the criteria of the American College of Rheumatology
3. Grade 3 Kellgren and Lawrence radiographic staging, in which the severity of the arthritis is assessed on a scale from 0-4, hypothesizing a sequential evolution from the manifestation of osteophytes through a reduction in the width of the joint space, to subchondral sclerosis and finally the formation of cysts
4. Frequent joint pain (several days a week) for at least 6 months before recruitment;
5. Pain in the knee, scored at least 2 cm on a 10 centimetric visual analogic scale (VAS), where 0 means no pain and 10 is the worst pain possible;
6. A score of >2 on the Lequesne pain-function index (LI). The LI is a disease-specific validated questionnaire that poses a series of questions about pain in the knee (five questions on a scale from 0 to 2, where 0 indicates no pain and 2 intense pain), functional limitation (four questions, using the same scale) and maximum walking distance (one question, with a score from 0 to 6, where 0 indicates the ability to walk for an unlimited distance and 6, the inability to cover 100 m). The maximum worst final score is 24.
Lack of symptoms in other joints was not taken into consideration.
Key exclusion criteria1. Previous surgery of the affected knee
2. Disease processes such as rheumatoid arthritis, autoimmune diseases, systemic diseases, and tumors
3. Severe obesity (BMI >40 kg/m2)
4. Allergy to shellfish
5. Altered blood chemistry and kidney, liver, and metabolic (diabetes mellitus) function;
6. Intra-articular hyaluronic acid/cortisone infiltrations to the affected knee within 3 months before the start of the study
7. Systemic cortisone treatment taken within 3 months before the start of the study
8. Supplements (glucosamine, chondroitin sulfate, bromeline, etc) taken within 3 months before the start of the study (patients were also informed that they were not to be taken for the following 6 months).
Date of first enrolment01/06/2013
Date of final enrolment01/08/2014

Locations

Countries of recruitment

  • Italy

Study participating centres

General Hospital of Bari
Piazza g.cesare 11
Bari
70124
Italy
Policlinico di Bari
Italy

Sponsor information

Laborest Spa
Industry

Via vicinale di Parabiago, n 22
Nerviano (Milan)
20014
Italy

Phone +39 (0)331 748523
Email L.Secondini@laborest.com
Website http://www.laborest.com/

Funders

Funder type

Research organisation

Laborest Spa (Italy)

No information available

Results and Publications

Intention to publish date
Individual participant data (IPD) Intention to shareNo
IPD sharing plan summaryNot provided at time of registration
Publication and dissemination planWe plan to submit an article to publish in BMC Journals (for example, BMC Complementary and Alternative Medicine).
IPD sharing plan