Assessment of the Effects of Chitosan, Chitooligosaccharides and Their Derivatives on Lemna minor.

Chitosan, chitooligosaccharides and their derivatives' production and use in many fields may result in their release to the environment, possibly affecting aquatic organisms. Both an experimental and a computational approach were considered for evaluating the effects of these compounds on Lemna minor. Based on the determined EC50 values against L. minor, only D-glucosamine hydrochloride (EC50 = 11.55 mg/L) was considered as "slightly toxic" for aquatic environments, while all the other investigated compounds, having EC50 > 100 mg/L, were considered as "practically non-toxic". The results obtained in the experimental approach were in good agreement with the predictions obtained using the admetSAR2.0 computational tool, revealing that the investigated compounds were not considered toxic for crustacean, fish and Tetrahymena pyriformis aquatic microorganisms. The ADMETLab2.0 computational tool predicted the values of IGC50 for Tetrahymena pyriformis and the LC50 for fathead minnow and Daphnia magna, with the lowest values of these parameters being revealed by totally acetylated chitooligosaccharides in correlation with their lowest solubility. The effects of the chitooligosaccharides and chitosan on L. minor decreased with increased molecular weight, increased with the degree of deacetylation and were reliant on acetylation patterns. Furthermore, the solubility mainly influenced the effects on the aqueous environment, with a higher solubility conducted to lower toxicity.

Fabrication and assessment of a novel hybrid scaffold consisted of polyurethane-gellan gum-hyaluronic acid-glucosamine for meniscus tissue engineering.

The meniscus has inadequate intrinsic regenerative capacity and its damage can lead to degeneration of articular cartilage. Meniscus tissue engineering aims to restore an injured meniscus followed by returning its normal function through bioengineered scaffolds. In the present study, the structural and biological properties of 3D-printed polyurethane (PU) scaffolds dip-coated with gellan gum (GG), hyaluronic acid (HA), and glucosamine (GA) were investigated. The optimum concentration of GG was 3% (w/v) with maintaining porosity at 88.1%. The surface coating of GG-HA-GA onto the PU scaffolds increased the compression modulus from 30.30 kPa to 59.10 kPa, the water uptake ratio from 27.33% to 60.80%, degradation rate from 5.18% to 8.84%, whereas the contact angle was reduced from 104.8° to 59.3°. MTT assay, acridine orange/ethidium bromide (AO/EB) fluorescent staining, and SEM were adopted to assess the behavior of the seeded chondrocytes on scaffolds, and it was found that the ternary surface coating stimulated the cell proliferation, viability, and adhesion. Moreover, the coated scaffolds showed higher expression levels of collagen II and aggrecan genes at day 7 compared to the control groups. Therefore, the fabricated PU-3% (w/v) GG-HA-GA scaffold can be considered as a promising scaffold for meniscus tissue engineering.

Assessment of pharmacy students' knowledge, attitude, and practice toward herbal dietary supplements.

Objective: Although there has been an expanded use of herbal supplements worldwide, data concerning their consumption patterns and knowledge are limited. Consequently, the present study aimed to assess the knowledge, attitude, and practice of Lebanese pharmacy students toward herbal dietary supplements. Participants and methods: A cross-sectional observational study was conducted by administering a 23-items' survey to a convenient sample of pharmacy students. Results: Out of 355 pharmacy students assessed, 168 were using at least one dietary supplement, mainly to treat health problems. Their primary source of information was the Internet. Health benefits of Ginkgo Biloba were known by 63% while that of Glucosamine by 12%. Similarly, side effects of Ginkgo Biloba were recognized by 62% while that of St. John's Wort by only 2%. Conclusion: Despite the comprehensive coverage of herbal supplements in the pharmacy curriculum, some were weakly known namely; Glucosamine and St. John's Wort. Consequently, emphasis should be done to fill the gap.

99mTc-labelled glucosamine in the assessment of systemic sclerosis inflammatory lung disease: a novel inexpensive investigative tool with predictive value.

OBJECTIVE: To evaluate the role of 99mTc-labelled glucosamine [99mTc-ECDG] as a clinical biomarker for the early detection of interstitial lung disease (ILD) in systemic sclerosis (SSc). METHODS: In this prospective pilot study, glucosamine scanning (GS) was performed in 15 SSc patients, with and without ILD. Collected data included patient disease characteristics, autoantibody profile, GS results, high-resolution computerised tomography [HRCT], pulmonary function tests [PFT], and transthoracic echocardiogram [TTE]. Glucosamine results were correlated with patient clinical profile, HRCT, and PFT's findings. RESULTS: Lung uptake of 99mTc-ECDG was high in 4 patients, moderate in 3, mild in 5, and normal in 3 with SSc, respectively. Of the patients with high and moderate uptake there was a 100% correlation between 99mTc-ECDG uptake and HRCT showing ILD. Of the 5 patients with mild 99mTc-ECDG uptake, 4 patients had aspiration pneumonia, and 1 had early ILD using HRCT. Of the 3 patients with normal 99mTc-ECDG, 2 had normal HRCTs; the third had severe pulmonary arterial hypertension with minimal HRCT changes of ILD. High and moderate 99mTc-ECDG lung uptake predicted abnormal PFT's in 100% of cases. In 3 patients, there was less extensive disease depicted on the 99mTc-ECDG scans than on the HRCT. These patients demonstrated a more favourable outcome than would have been expected from the HRCT scans alone. Mild 99mTc-ECDG lung uptake correlated with abnormal PFT's in 60% of cases. The pattern of 99mTc-ECDG uptake was excellent (100%) at distinguishing metabolically active ILD from aspiration pneumonia. Diffuse uptake was noted in the former and patchy uptake in the latter disease entity. CONCLUSION: Increased 99mTc-ECDG uptake in scleroderma lung correlated positively with both structural and functional changes. 99mTc-ECDG is a useful adjunct helping elucidate inflammation secondary to aspiration pneumonia and/or other causes of abnormal PFT's.

Chitin derivatives of NAG and chitosan nanoparticles from marine disposal yards and their use for economically feasible fish feed development.

Globally, the disposal of shellfishery waste is a major challenge and causes a risk to the coastal region. For potential development in aquaculture, the use of safe supplements to improve fish production and health is important. Chitosan (CS) used as feed additives for several fish species that enhanced production and immunity. The present study was intended to assess the effect of feed additives N-acetyl-d-glucosamine (NAG) loaded chitosan nanoparticles (CSNPs) on productivity, survival rate, and protein conversion efficiency of Oreochromis niloticus (L.). This is the first report on the effect of CSNPs and NAG loaded CSNPs as feed additives enhanced growth performance and non-specific immunity of O. niloticus. CSNPs and NAG loaded CSNPs were synthesized and characterized by scanning and transmission electron microscope, FT-IR, X-ray diffraction, particle size distribution, and zeta sizer. Fish (15.30 ± 0.23 g) administered diets fortified with 0.0, 0.25, 0.5, 1.0, and 2.0 g CSNPs/kg feed loaded with NAG for 45 d. The diets containing 1.0 g/kg NAG loaded CSNPs enhanced specific growth rate, weight gain, survival rate, respiratory burst, and lysozyme activities of tilapia compared control group. The data shows biologically active CSNPs and NAG loaded CSNPs are potent antimicrobial agents against selected bacterial pathogens. In conclusion, the findings suggested that the dietary supplement containing NAG loaded CSNPs significantly increased immune-modulatory properties, growth performance, and enhanced their disease resistance of Nile tilapia.

Cost-Effectiveness Assessment of Different Glucosamines in Patients with Knee Osteoarthritis: A Simulation Model Adapted to Germany.

BACKGROUND: The use of symptomatic slow-acting drugs for osteoarthritis (OA) (e.g., glucosamine, chondroitin) is largely debated in the scientific literature. Indeed, multiple formulations of these agents are available, both as pharmaceutical-grade products and as nutritional supplements , but while all preparations may claim to deliver a therapeutic effect, not all are supported by clinical evidence. Moreover, few data are available regarding the cost-effectiveness of all these formulations. Usually, access to individual patient data is required to perform economic evaluations of treatments, but it can be challenging to obtain. We previously developed a model to simulate individual health utility scores from aggregated data obtained from published OA trials. OBJECTIVE: In the present study, using our new simulation model, we investigated the costeffectiveness of different glucosamines used in Germany. METHODS: We used our validated model to simulate the utility scores of 10 published trials that used different glucosamine preparations. Using the simulated utility scores, the quality-adjusted life years (QALYs) were calculated using the area-under-the-curve method. We used the 2018 public costs of glucosamine products available in Germany to calculate the Incremental Cost/Effectiveness Ratio (ICER). We performed analyses for pharmaceutical-grade Crystalline Glucosamine Sulfate (pCGS) and other formulations of glucosamine (OFG). A cost-effectiveness cut-off of 30,000 €/QALY was considered. RESULTS: Of 10 studies in which utility was simulated, four used pCGS, and six used OFG. The ICER analyses showed that pCGS was cost-effective compared to a placebo, with an ICER of 4489 €/QALY at month 3, 4112 €/QALY at month 6, and 9983 €/QALY at year 3. The use of OFG was not cost-effective at any of the time points considered. CONCLUSION: Using our previously published model to simulate the individual health utility scores of patients, we showed that, in the German context, the use of pCGS could be considered costeffective, while the use of OFG could not. These results highlight the importance of the formulation of glucosamine.

European chondroitin sulfate and glucosamine food supplements: A systematic quality and quantity assessment compared to pharmaceuticals.

Chondroitin sulfate and glucosamine, commercialized as anti-osteoarthritis food supplements, do not undergo the strict quality controls of pharmaceuticals. In this paper a systematic multi-analytical approach was designed to analyse 25 food supplements from 8 European countries compared to 2 pharmaceuticals by using high performance anion-exchange chromatography with pulsed amperometric detection, size exclusion chromatography with triple detector array, capillary electrophoresis, mono and bi-dimensional NMR. Furthermore the biological activity was assessed on in vitro human synoviocyte and chondrocyte primary cell models. Most of the samples (over 19 out of 25) showed lower condroitin sulfate and glucosamine contents than the declared ones (up to -60.3%) while all of them showed a KS contamination (up to 47.1%). Mixed animal origin chondroitin sulfate and multiple molecular weight species were determined in more than 32% of the samples. Only 1 on 5 biologically screened samples had an effective action in vitro almost comparable to the pharmaceuticals.

Cost-effectiveness evaluation of glucosamine for osteoarthritis based on simulation of individual patient data obtained from aggregated data in published studies.

BACKGROUND: The economic evaluation of treatments usually requires access to individual patient data, which is difficult to obtain. Moreover, in osteoarthritis, health utility scores are unavailable and can be assessed only using a validated equation model based on various clinical data. We aimed to develop and validate a methodology to simulate individual health utility scores from aggregated clinical data available in published studies to calculate the cost-effectiveness of different glucosamine preparations (i.e., crystalline glucosamine sulfate, glucosamine sulfate, and glucosamine hydrochloride) used for osteoarthritis. METHODS: We developed a method to simulate individual utility values and validated the model by comparing the results obtained with the simulation and the results of one trial where the utility scores are available. Then, we simulated the utility scores of 10 published trials that used different glucosamine preparations. The utility estimates were used to calculate the quality-adjusted life year (QALY) using the area-under-the-curve method. Costs were for the glucosamine product only. The incremental cost/effectiveness ratio (ICER) was then calculated. RESULTS: The values of utility scores calculated from data sources and those simulated with the model were similar. From 10 studies where utility was simulated, four used crystalline glucosamine sulfate, and six used other formulations. The ICER revealed that compared to placebo, crystalline glucosamine sulfate only was cost-effective at all time points and up to 3 years with a median ICER of 5347.2 €/QALY at month 3, 4807.2 €/QALY at month 6 and 11535.5 €/QALY at year 3. The use of other formulations was not cost-effective. CONCLUSION: Using a new model to simulate individual health utility scores of patients included in ten published trials, ICER analysis showed that the use of crystalline glucosamine sulfate is cost-effective, while other formulations were not. The results confirm the importance of the formulation of glucosamine products.

Determination of 1-Deoxynojirimycin by a developed and validated HPLC-FLD method and assessment of In-vitro antioxidant, α-Amylase and α-Glucosidase inhibitory activity in mulberry varieties from Turkey.

BACKGROUND: Morus alba and Morus nigra leaves which have been widely used as herbal teas in Anatolian region of Turkey, were extracted twice by 50 mM HCI solution, derivatized with 9-fluorenylmethyl chloroformate and analyzed by reversed phase HPLC equipped with a fluorescence detector. HYPOTHESIS/PURPOSE: This study was performed to determine the main antidiabetic active compounds 1-deoxynojirimycin by HPLC method and evaluate the in-vitro antioxidant and antidiabetic activity of ethanol extracts prepared from Morus alba L. and Morus nigra leaves. STUDY DESIGN: A reliable simple, and rapid high-performance liquid chromatographic (HPLC) method for the determination of 1-deoxynojirimycin in M. alba L. and M. nigra leaves with fluorimetric detection after pre-column derivatization with 9-fluorenylmethyl chloroformate was developed. In addition, the chemical composition of ethanol extract of mulberry leaves was analyzed with GC-MS. METHODS: Separation and quantitation were performed on C18, 250 × 4.6 mm, 5 µm analytical column. Mobile phase consisted of acetonitrile and 0.1% acetic acid solution (1:1, v/v) was performed applied to the column 1.0 ml/min flow rate at 26 °C. Potential antioxidant activity of ethanol extract of different mulberry varieties were evaluated by DPPH, and ABTS radical scavenging assay as well as total phenol and flavonoid content were determined. In addition, α-amylase and α-glucosidase activity was determined by 96-well plate method to evaluate the probable antidiabetic potential use of Turkish mulberry leaves. RESULTS: The isocratic HPLC method showed excellent correlation coefficient (r2 = 0.9985) between 0.3 and 30 µg/ml calibration points. The method was specific and sensitive with detection and quantification limits of 1.07 and 3.27 ng/ml, respectively. Intraday and interday method precision (n = 5) were < 7.3 (RSD%). Intraday and interday method accuracy (n = 5) were between 3.77 and (-8.35) (RE%). The average method recovery (n = 3) was 102.5%. The results showed that the content of 1-deoxynojirimycin in leaves of Morus alba L. was 0.103% (n = 3), and in leaves of M. nigra L. was 0.102%. 2-hexadecen-1-ol, oleamide, 2-propenoic acid, and cyclododecane were identified as the major compounds by GC-MS in the ethanol extract of mulberry leaves. CONCLUSION: The obtained robustness values from emission and excitation detection, mobile phase ingredients and flow rates changes showed that method was very strong. This work contributes to the knowledge of antioxidant and antidiabetic properties of Morus species, thus may be provide useful data in evaluation of food products and pharmaceutical preparations produced from Morus species.

Differentiation of patented crystalline glucosamine sulfate from other glucosamine preparations will optimize osteoarthritis treatment.

Symptomatic slow-acting drugs for osteoarthritis (SYSADOAs) are recommended for the medium- to long-term management of knee osteoarthritis (OA) due to their abilities to control pain, improve function and delay joint structural changes. Among SYSADOAs, evidence is greatest for the patented crystalline glucosamine sulfate (pCGS) formulation (Mylan). Glucosamine is widely available as glucosamine sulfate (GS) and glucosamine hydrochloride (GH) preparations that vary substantially in molecular form, pharmaceutical formulation and dose regimen. Only pCGS is given as a highly bioavailable once-daily dose (1500 mg), which consistently delivers the plasma levels of around 10 µmol/L required to inhibit interleukin-1-induced expression of genes involved in the pathophysiology of joint inflammation and tissue destruction. Careful consideration of the evidence base reveals that only pCGS reliably provides a moderate effect size on pain that is higher than paracetamol and equivalent to non-steroidal anti-inflammatory drugs (NSAIDs), while non-crystalline GS and GH fail to reach statistical significance for pain reduction. Chronic administration of pCGS has disease-modifying effects, with a reduction in need for total joint replacement lasting for 5 years after treatment cessation. Pharmacoeconomic studies of pCGS demonstrate long-term reduction in additional pain analgesia and NSAIDs, with a 50% reduction in costs of other OA medication and healthcare consultations. Consequently, pCGS is the logical choice, with demonstrated medium-term control of pain and lasting impact on disease progression. Physician and patient education on the differentiation of pCGS from other glucosamine formulations will help to improve treatment selection, increase treatment adherence, and optimize clinical benefit in OA.

Inappropriate claims from non-equivalent medications in osteoarthritis: a position paper endorsed by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO).

Osteoarthritis (OA) is a progressive joint disease, that occurs frequently in the aging population and is a major cause of disability worldwide. Both glucosamine and chondroitin are biologically active molecules that are substrates for proteoglycan, an essential component of the cartilage matrix. Evidence supports the use of glucosamine and chondroitin as symptomatic slow-acting drugs for osteoarthritis (SYSADOAs) with impact on OA symptoms and disease-modifying effects in the long term. Glucosamine and chondroitin are administered in exogenous form as a sulfate salt and multiple formulations of these agents are available, both as prescription-grade products and nutritional supplements. However, while all preparations may claim to deliver a therapeutic level of glucosamine or chondroitin not all are supported by clinical evidence. Only patented crystalline glucosamine sulfate (pCGS) is shown to deliver consistently high glucosamine bioavailability and plasma concentration in humans, which corresponds to demonstrated clinical efficacy. Similarly, clinical evidence supports only the pharmaceutical-grade chondroitin sulfate. The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) advocates, through careful consideration of the evidence base, that judicious choice of glucosamine and chondroitin formulation is essential to maximize clinical benefit, patient adherence and satisfaction with treatment. In future, the ESCEO recommends that complex molecules with biological activity such as pCGS may be treated as "biosimilars" akin to the European Medicines Agency guidance on biological medicinal products. It seems likely that for all other complex molecules classed as SYSADOAs, the recommendation to use only formulations clearly supported by the evidence-base should apply.

Techno-economic analysis of glucosamine and lipid production from marine diatom Cyclotella sp.

A techno-economic analysis (TEA) was performed on glucosamine and lipid production from a marine diatom Cyclotella sp. in raceway open pond (RWP) and tubular photobioreactor (PBR) cultivation systems. Two PBR operating schemes were assessed: one to produce high lipid (HL) content, and another to produce high chitin (HC) content. In order to generate 1kg of glucosamine, 9700kg (RWP)/1050kg (PBR HL) freshwater, 40kg CO2, 0.70kg nitrogen, 0.18kg phosphorus, and 1.2kg silicon nutrients are required for algae cultivation with water and nutrient recovery. With a price of $1.5 for lipid as coproduct, the projected selling price of glucosamine were $35/kg, $106/kg and $82/kg for RWP, PBR HL, and PBR HC systems, respectively. Currently, these prices are not competitive with industrial shellfish-derived glucosamine, but can be reduced by technology improvements such as producing food grade lipid, increasing algal productivity or chitin content.

Glucosamina y glucosamina-condroitín sulfato en el tratamiento de la osteoartrosis / Glucosamine and glucosamine-chondroitin sulfate in the treatment of osteoarthritis

ANTECEDENTES: La osteoartrosis es la enfermedad más común del sistema músculo-esquelético y constituye la principal causa de discapacidad o invalidez de todas las enfermedades crónicas. Desde 1990 surgen agentes "condromoduladores", muchos de venta libre, con discutido valor terapeútico y creciente demanda inducida por el complejo médico industrial. OBJETIVO: Evaluar la eficacia y seguridad de la Glucosamina y de la combinación Glucosamina y Condroitín sulfato en el tratamiento de la osteoartrosis. MÉTODO: Revisión sistemática donde se incluyeron 11 revisiones sistemáticas y metaanálisis, de 106 elegibles, publicados entre 2000 y 2015, con los siguientes puntos finales primarios: dolor evaluado por diferentes escalas, función, rigidez y eventos adversos; puntos finales secundarios: disminución del ancho del espacio articular, evaluación global del paciente y evaluación global del médico. RESULTADOS: Para los puntos finales primarios, las revisiones que ajustaron por sesgos y estratificaron por cada uno de ellos: ICCAs de alta calidad, el ocultamiento y el enmascaramiento adecuado, el análisis por intención de tratar, la independencia de la financiación de la industria y el mayor tamaño de la muestra, observaron un tamaño del efecto de moderado a leve o nulo (índice de Cohen de 0.0 a 0.5) en los grupos tratados con glucosamina o glucosamina-condroitín asociados, cuando se los comparó con placebo o AINES. Otras debilidades metodológicas fueron las diferencias en el periodo de seguimiento entre los participantes, las dosis y vías de administración, el tipo de preparaciones de glucosamina y sesgos de publicación. Esto genera eterogeneidad entre los estudios primarios con un elevado índice de inconsistencia, que tiene potencialidad para desviar la medida común de resultados de los MA. CONCLUSIONES: Para los puntos finales primarios, no hubo diferencias significativas de eficacia al comparar el sulfato de glucosamina contra placebo, aunque parecería mejorar su efecto si está asociada al condroitín sulfato. Tampoco se encontraron diferencias cuando se comparó la glucosamina o su asociación a condroitín sulfato con AINES. Los eventos adversos de la glucosamina, ya sea administrada sola o en combinación al condroitín sulfato, son más infrecuentes y menos serios que los que presentan los AINEs, pero aún no está claro si modifica el metabolismo de la glucosa. El clorhidrato de glucosamina no es efectivo por vía oral. Las evidencias muestran que el efecto de estos compuestos sobre el dolor y la funcionalidad articular es, nulo o leve, por lo que su valor en la clínica es limitado y no agregan valor terapéutico al tratamiento de la osteoartrosis.(AU)

Ligand anchored poly(propyleneimine) dendrimers for brain targeting: Comparative in vitro and in vivo assessment.

The present investigation was aimed at developing various ligands-anchored dendrimers and comparing their brain targeting potential at one platform. Sialic acid (S), glucosamine (G) and concanavalin A (C) anchored poly(propyleneimine) (PPI) dendritic nanoconjugates were developed and evaluated for delivery of anti-cancer drug, paclitaxel (PTX) to the brain. MTT assay on U373MG human astrocytoma cells indicated IC50 values of 0.40, 0.65, 0.95, 2.00 and 3.50µM for PTX loaded SPPI, GPPI, CPPI, PPI formulations, and free PTX, respectively. The invivo pharmacokinetics and biodistribution studies in rats showed significantly higher accumulation of PTX in brain as compared to free PTX. The order of targeting potential of various ligands under investigation was found as sialic acid>glucosamine>concanavalin A. Thus, it can be concluded that sialic acid, glucosamine and Con A can be used as potential ligands to append PPI dendrimers for enhanced delivery of anticancer drugs to the brain for higher therapeutic outcome.

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)

Efficacy and safety of glucosamine sulfate in the management of osteoarthritis: Evidence from real-life setting trials and surveys.

The European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) treatment algorithm recommends chronic symptomatic slow-acting drugs for osteoarthritis (SYSADOAs) including glucosamine sulfate (GS) and chondroitin sulfate (CS) as first-line therapy for knee osteoarthritis (OA). Numerous studies are published on the use of SYSADOAs in OA; however, the efficacy of this class is still called into question largely due to the regulatory status, labeling and availability of these medications which differ substantially across the world. Examination of the evidence for the prescription patented crystalline GS (pCGS) formulation at a dose of 1500mg once-daily demonstrates superiority over other GS and glucosamine hydrochloride (GH) formulations and dosage regimens. Thus, the ESCEO task force advocates differentiation of prescription pCGS over other glucosamine preparations. Long-term clinical trials and real-life studies show that pCGS may delay joint structural changes, suggesting potential benefit beyond symptom control when used early in the management of knee OA. Real-life pharmacoeconomic studies demonstrate a long-term reduction in the need for additional pain analgesia and non-steroidal anti-inflammatory drugs (NSAIDs) with pCGS, with a significant reduction of over 50% in costs associated with medications, healthcare consultations and examinations over 12 months. Furthermore, treatment with pCGS for at least 12 months leads to a reduction in the need for total joint replacement for at least 5 years following treatment cessation. Thus, pCGS (1500mg od) is a logical choice to maximize clinical benefit in OA patients, with demonstrated medium-term control of pain and lasting impact on disease progression.

A consensus statement on the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) algorithm for the management of knee osteoarthritis-From evidence-based medicine to the real-life setting.

The European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) published a treatment algorithm for the management of knee osteoarthritis (OA) in 2014, which provides practical guidance for the prioritization of interventions. Further analysis of real-world data for OA provides additional evidence in support of pharmacological interventions, in terms of management of OA pain and function, avoidance of adverse events, disease-modifying effects and long-term outcomes, e.g., delay of total joint replacement surgery, and pharmacoeconomic factors such as reduction in healthcare resource utilization. This article provides an updated assessment of the literature for selected interventions in OA, focusing on real-life data, with the aim of providing easy-to-follow advice on how to establish a treatment flow in patients with knee OA in primary care clinical practice, in support of the clinicians' individualized assessment of the patient. In step 1, background maintenance therapy with symptomatic slow-acting drugs for osteoarthritis (SYSADOAs) is recommended, for which high-quality evidence is provided only for the prescription formulations of patented crystalline glucosamine sulfate and chondroitin sulfate. Paracetamol may be added for rescue analgesia only, due to limited efficacy and increasing safety signals. Topical non-steroidal anti-inflammatory drugs (NSAIDs) may provide additional symptomatic treatment with the same degree of efficacy as oral NSAIDs without the systemic safety concerns. Oral NSAIDs maintain a central role in step 2 advanced management of persistent symptoms. However, oral NSAIDs are highly heterogeneous in terms of gastrointestinal and cardiovascular safety profile, and patient stratification with careful treatment selection is advocated to maximize the risk:benefit ratio. Intra-articular hyaluronic acid as a next step provides sustained clinical benefit with effects lasting up to 6 months after a short-course of weekly injections. As a last step before surgery, the slow titration of sustained-release tramadol, a weak opioid, affords sustained analgesia with improved tolerability.

Efectividad y seguridad de condroitín comparado con acetaminofén, antiinflamatorios no esteroideos, glucosamina, condroitín más glucosamina, diacereina, ácido hialurónico ó fitoterapéuticos, en pacientes con osteoartrosis / Effectiveness and safety of chondroitin compared to acetaminophen, non-steroidal anti-inflammatory drugs, glucosamine, chondroitin plus glucosamine, diacerein, hyaluronic acid or phytotherapeutic agents in patients with osteoarthrosis

Introducción: la OA es la forma más común de enfermedad de las articulaciones y la principal causa de discapacidad de las personas de la tercera edad. Su alta prevalencia en una población que usualmente tiene comorbilidades asociadas que requieren otros medicamentos obliga a buscar otras alternativas terapéuticas con mínimos eventos adversos y pocas interacciones medicamentosas. Condroitín es un medicamento regenerador de cartílago que se ha usado en el manejo de estos pacientes. Esta evaluación tecnológica se desarrolló en el marco de la actualización integral del Plan Obligatorio de Salud para el año 2015. Objetivo: evaluar la efectividad y seguridad del uso de condroitín comparado con acetaminofén, antiinflamatorios no esteroideos, glucosamina, condroitín más glucosamina, diacereina, ácido hialurónico ó fitoterapéuticos, en pacientes osteoartrosis. Metodología: la evaluación fue realizada de acuerdo con un protocolo definido a priori por el grupo desarrollador. Se realizó una búsqueda sistemática en MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects y LILACS, con restricción al idioma inglés y español y limitada a revisiones sistemáticas publicadas en los últimos cinco años y ensayos clínicos sin restricción de tiempo. Las búsquedas electrónicas fueron hechas entre octubre y diciembre de 2014 y se complementaron mediante búsqueda manual en bola de nieve y una consulta con expertos temáticos. La tamización de referencias se realizó por un revisor. La selección de estudios fue realizada mediante la revisión en texto completo de las referencias preseleccionadas, verificando los criterios de elegibilidad. La calidad de los estudios fue valorada con la herramienta de riesgo de sesgo de la Colaboración Cochrane. Las características de los estudios fueron extraídas a partir de las publicaciones originales. Se realizó una síntesis narrativa de las estimaciones del efecto para las comparaciones y desenlaces de interés a partir de los estudios de mejor calidad. Se estimaron medidas combinadas del efecto a través de un metanálisis con el método de Mantel-Haenszel y un modelo de efectos aleatorios, empleando el programa RevMan 5.2. Resultados: condroitín es semejante a los AINEs, glucosamina y glucosamina más condroitín en mejorar los desenlaces como dolor y funcionalidad a los seis meses y el desenlace radiológico proporción de pacientes con progresión de la disminución de la amplitud del espacio articular. Los AINEs, glucosamina y glucosamina más condroitín son superiores en los desenlaces rigidez a los seis meses según puntaje en la escala WOMAC (RR=5.97 IC 95% 1.45, 10.49). Condroitín sulfato es no inferior a pascledina en estos mismos desenlaces. Además en relación a seguridad no se reportó ningún evento adverso serio a ninguno de los medicamentos evaluados, incluyendo condroitín. La adherencia al tratamiento fue muy buena tanto a los seis meses como a los 24 meses y la percepción de tolerancia fue superior al 94%. Conclusiones: condroitín es semejante en efectividad y seguridad a glucosamina, glucosamina más condroitín, AINEs y pascledina en pacientes con osteoartrosis.(AU)

Microbial degradation of chitin waste for production of chitosanase and food related bioactive compounds.

Ecological samples rich in microbial diversity like cow dung, legume rhizosphere, fish waste and garden soil were used for isolation of chitosan-degrading microorganisms. Selected isolates were used for production of chitosanase and food related bioactive compounds by conversion of biowaste. Production of glucosamine (Gln), N-acetylglucosamine (NAG), chitooligosaccharides (COS), antioxidants, antibacterial compounds and prebiotics was carried out by microbial fermentation of biowaste. The highest chitosanase activity (8 U/mL) was observed in Aspergillus sp. isolated from fish market waste and it could produce Gln and NAG while Streptomyces sp. isolated from garden soil was able to produce COS along with Gln and NAG. Radical scavenging activity was observed in culture supernatants of 35% of studied isolates, and 20% isolates secreted compounds which showed positive effect on growth of Bifidobacterium. Antibacterial compounds were produced by 40% of selected isolates and culture supernatants of two microbial isolates, Streptomyces zaomyceticus C6 and one of garden soil isolates, were effective against both gram positive and negative bacteria.