NHS Western Cheshire does not commission the prescribing of glucosamine products, with or without chondroitin for any musculo-skeletal conditions.

Transcription

1 Prescribing Policy Glucosamine Policy Statement: Date of Approval: 10 th December 2009 This policy defines the decision made by the NHS Western Cheshire Clinical Priorities Committee following a review of the evidence available to assess the efficacy of glucosamine with or without chondroitin. NHS Western Cheshire does not commission the prescribing of glucosamine products, with or without chondroitin for any musculo-skeletal conditions. Note: Patients who are not eligible for treatment under this policy may be considered on an individual basis where their GP or consultant believes exceptional circumstances exist that warrant deviation from the rule of this policy. Individual cases will be reviewed at the PCT Bespoke Care Panel upon receipt of a completed application form from the Patient s GP, Consultant or Clinician. Applications can not be considered from patients personally. Version 1.0 Approved by (committee) Clinical Commissioning and Strategy Committee Date Approved: 10 th December 2009 Date of implementation: 1 st March 2010 Produced by (Title); Prescribing policy development group Review Date: Earliest of either SHA guidance, NICE publication or five years from issue.

2 Further information about this document: Document name Category of Document in The Policy Schedule Author(s) Contact(s) for further information about this document Prescribing Policy Glucosamine Commissioning Policy Prescribing policy development group Telephone: This document should be read in conjunction with Published by Copies of this document are available from Version Control: Prioritisation framework NHS Western Cheshire 1829 Building Countess of Chester Health Park Liverpool Road Chester, CH2 1HJ Main Telephone Number: (Freephone) Main Address: Website: Copyright NHS Western Cheshire, All Rights Reserved Version History: Version Number Reviewing Committee / Officer Date 0.1 Prescribing policy development group 2/9/ Formatting amendments 3/9/ Clinical Priorities Committee 10/9/ Area Prescribing Committee 26/11/ Clinical Commissioning and Strategy Committee 10/12/09 1

3 This document can be made available in a range of alternative formats including various languages, large print, Braille and audio cassette. To discuss your requirements please ring

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5 Contents 1. BACKGROUND 2. EVIDENCE 3. CONCLUSIONS 4. RESPONSIBILITY FOR IMPLEMENTATION 5. REFERENCES 6. ROUTE FOR POLICY DEVELOPMENT AND RATIFICATION The following terms are used in this document Cochrane Review The Cochrane collaboration systematically reviews evidence of effectiveness of healthcare interventions, including medicines and surgical procedures. The reviews are regularly updated and are respected worldwide. Prescribing Policy Glucosamine Version: 1.0

6 1. BACKGROUND 1.1 The purpose of this policy is to outline the decision taken by NHS Western Cheshire Prioritisation Committee regarding the prescribing of glucosamine. This policy applies to all prescribers, both medical and non-medical. 1.2 Glucosamine occurs naturally in cartilage and synovial fluid. Although the mechanism of action is unknown, it is thought to have a chondroprotective effect and thus might be useful in osteoarthritis which commonly affects the hip, knee and spine. 1.3 Two forms of glucosamine are available glucosamine sulphate and glucosamine hydrochloride. The former is only available in the United Kingdom as an unlicenced over the counter health food preparation. The latter is a medicine (Alateris ) available only on prescription. 1.4 Glucosamine is thought to be effective in reducing pain and improving functionality 2. EVIDENCE 2.1 A panel of European experts reviewed the data on glucosamine (sulphate) for hip osteoarthritis and concluded that glucosamine was ineffective for this condition. However, the panel found high quality evidence that glucosamine was more effective than placebo in osteoarthritis of any joint A Cochrane review examined the use of glucosamine (both preparations) in the management of non-specific osteoarthritis. 2 It concluded that the sulphate preparation was superior to placebo in relieving pain and improving function, whereas the hydrochloride form was ineffective. 2.3 A Drug and Therapeutics Bulletin (DTB) reviewed the evidence specifically for the glucosamine hydrochloride (the United Kingdom licensed) product in the management of knee arthritis. 3 It concluded that glucosamine hydrochloride should not be prescribed owing to lack of evidence and further warned of the dangers of over-coagulation when co-prescribed with warfarin. 2.4 Finally, in its Clinical Guidance on the care and management of osteoarthritis in adults, the National Institute for Health and Clinical Excellence (NICE) recommended against the use of glucosamine or chondroitin products. 4 Prescribing Policy Glucosamine Version: 1.0

7 3. CONCLUSIONS 3.1 There is no reliable evidence for the prescribing of glucosamine hydrochloride (Alateris ) in the management of osteoarthritis. This seems to be the generally held consensus view. 3.2 The Scottish Medicines Consortium also does not recommend glucosamine hydrochloride for relief of symptoms in people with mild to moderate osteoarthritis of the knee There is some evidence that glucosamine sulphate is effective although this is manufactured as a health food product of variable quality and prescribing is not approved of either glucosamine sulphate or glucosamine hydrochloride. 3.4 Whilst evidence of benefit is minimal, there is little evidence of harm. Patients who wish to take glucosamine sulphate, may purchase an over the counter product from a reputable source, although they should refrain form doing so if they are also taking warfarin. 4. RESPONSIBILITY FOR IMPLEMENTATION 4.1 Responsibility for implementation lies with the Practice Based Commissioning Consortium and the Area Prescribing Committee. 5. REFERENCES 1 Zhang W, Doherty M, Arden N et al. EULAR evidence based recommendations for the management of hip osteoarthritis: report of a task force of the EULAR standing committee for international clinical studies including therapeutics (ESCISIT). Ann Rheum Dis 2005; 64: Towheed T, Maxwell L, Anastassiades TP et al. Glucosamine therapy for treating osteoarthritis Cochrane Database of Systematic Reviews 2005 (updated 2008) 3 Glucosamine for knee osteoarthritis What s new. DTB 2008; 46: National Institute for Health and Clinical Excellence (2008) Clinical guideline no 59. Osteoarthritis: The care and management of osteoarthritis in adults. London: NICE. 5 Scottish Medicines Consortium Glucosamine(as hydrochloride) 2008 Available at: 8%20for%20website.pdf Accessed 25 th August 2009 Prescribing Policy Glucosamine Version: 1.0

8 6. ROUTE FOR POLICY DEVELOPMENT AND RATIFICATION Evidence researched by Public Health Specialist Evidence reviewed by Task & Finish Group and draft policy developed Draft policy reviewed and agreed by Area Prescribing Committee Draft policy finalised and ratified by Clinical Commissioning and Strategy Committee Policy distributed to relevant stakeholders and uploaded on the PCT extranet and website Prescribing Policy Glucosamine Version: 1.0