Chondroxide-Maximum cream external 8% 50 g tube/pack of cards x1

Chondroxide or Teraflex – which is better?

Manufacturer: Bayer (Russia)
Release form: capsules

Active ingredient: chondroitin, glucosamine

Both drugs have the same indications, but when comparing them, some differences are noted:

• Chondroxide tablets contain 1 active substance – chondroitin. The therapeutic effect occurs after six months. The drug is approved for use only by adults. An overdose of the medication is possible, but there are fewer side effects;
• Theraflex capsules contain 2 substances – chondroitin and glucosamine. The therapeutic effect occurs after 3 months. The analogue is approved for use from 16 years of age. There is no information about overdose, but there are more side effects.

In this case, Teraflex will be more effective not only when used internally, but also in the form of an ointment due to the active ingredients. The best for athletes and teenagers will be Teraflex, for elderly patients - Chondroxide.

Chondroxide Maximum analogues

Manufacturer: Nizhpharm JSC (Russia)

Release form: cream

Active ingredient: Glucosamine

Thanks to the presence of a wide range of Chondroxide analogues, it is always possible to select an effective drug for the patient that will have a therapeutic effect for joint diseases. The following drugs are analogous to the action of Chondroxide Maximum:

• Sustilak;
• Glucosamine;
• Chondroglucide;
• Ambene bio;
• Rumalon;
• Chondrolone;
• Arttrafic.

These drugs actively relieve pathological symptoms and have a positive effect on the cellular structure of cartilage tissue.

Chondroxide ointment or gel – which is better?

Despite the fact that the active ingredient in both drugs is chondroitin, they differ in the following parameters:

• in additional ingredients included in the structure of the medicine;
• in their texture;
• pH of drugs.

Chondroxide ointment is made on the basis of oils and fats and has a denser texture. It must be applied by rubbing in with your hands. The structure of the gel is lighter and hydrophilic. Its PH is close to the acid-base value of the skin, which allows it to be more intensively absorbed into the skin.

Due to its light texture, Chondroxide gel is easily absorbed without leaving an oily sheen on the skin and hands. The medicinal components included in the gel penetrate more actively into the joint. If the pain syndrome is severe, then preference should be given to the gel, since it is easier to apply to the sore joint and has a faster therapeutic effect.

Analogues of Chondroxide tablets

When treating joint diseases, Chondroxide tablets can be replaced with their cheap analogues, which have identical indications and mechanism of action:

• Mucosat;
• Artrin;
• Biartrin;
• Ibuprofen;
• Artron Complex.

These analogues of Chondroxide for external use have anti-inflammatory, regenerating and analgesic effects. Actively penetrating through the skin into the area of ​​the affected joint, they help relieve swelling, improve the consistency of synovial fluid and improve the cellular structure of cartilage.

Chondroxide tablets can be replaced with analogues that are available in the same form. These are Structum and Hondrex.

Specialists

Lapshina S. A.1, 2

, Afanasyeva M.A.
2
, Sukhorukova E.V.
2
, Nigmatullina Z.N.3, Mingaleeva G.F.3

1Kazan State Medical University

2State Autonomous Institution "Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan"»

3 State Autonomous Institution “City Clinical Hospital No. 7”, Kazan

Osteoarthritis is a chronic progressive disease of the joints, characterized by primary degeneration of articular cartilage with subsequent changes in the articular surfaces, subchondral bone, proliferation of marginal osteophytes and the development of deformities.

Osteoarthritis (OA) is the most common disease of the musculoskeletal system. According to WHO, OA affects about 4% of the world's population, and in 10% of cases it causes disability. The disease leads to a deterioration in the quality of life of patients and significant financial costs for both the patient and society as a whole. The economic damage associated with the incidence of OA in a number of countries ranges from 1 to 2.5% of the gross national product, including both direct costs of medical care and losses due to disability,

This disease is one of the main causes of premature disability and disability, second only to coronary heart disease in this regard, and the most common indication for joint replacement. According to multicenter epidemiological studies, the prevalence of OA among the population of the former USSR was 6.4% and correlates with age. According to rheumatologists in Europe and the USA, this disease accounts for up to 70% of all rheumatic diseases.

OA of the knee joint - gonarthrosis - accounts for 33.3% of all cases of OA (the second most common after OA of the hip joint). About 10% of the population over 55 years of age have signs of OA of the knee joints, while 25% of those suffering from gonarthrosis develop severe disability. The WHO report on the social impact of knee OA indicates that it is the 4th leading cause of disability in women and 8th in men. The annual incidence of arthroplasty operations among patients over 65 years of age suffering from gonarthrosis is 0.5-0.7 per 1000 population.

OA therapy is carried out in two directions - the use of analgesics and non-steroidal anti-inflammatory drugs (NSAIDs), which quickly relieve pain and inflammation in the joints, and the prescription of drugs aimed at slowing down the destruction of cartilage and the progression of the disease (glucosamine sulfate and chondroitin sulfate). The symptomatic effect of NSAIDs can reduce the intensity of pain, however, having a negative effect on the gastrointestinal tract, they do not prevent destructive changes in cartilage tissue and subchondral bone. Paracetamol recommended in guidelines in low doses has little effect on pain relief, and increasing doses sharply increases the risk of serious complications of therapy. Russia has accumulated quite a lot of experience in using drugs based on glucosamine sulfate. Glucosamine sulfate has chondroprotective properties, reduces the deficiency of glycosaminoglycans in the body, is a specific substrate and stimulator of the synthesis of hyaluronic acid and proteoglycans. Glucosamine sulfate helps restore the cartilage surfaces of peripheral joints and spinal joints. Has anti-inflammatory and analgesic properties. Reduces pain and the need to take non-steroidal anti-inflammatory drugs, inhibits the formation of superoxide radicals and enzymes that damage cartilage tissue (collagenase and phospholipase). An original solution to the possibility of using GS drugs was the creation of dosage forms for external use. When using drugs with chondroprotective properties, the effect usually occurs within 4-8 weeks from the start of treatment. This effect is expressed not only in slowing down the destruction of cartilage, but also in reducing pain. It should also be emphasized that no severe adverse reactions have been reported when taking them.

The purpose of this study is to evaluate the effectiveness and safety of Chondroxide® Maximum, a cream for external use, in the treatment of osteoarthritis of the knee joint. The effectiveness of therapy with Chondroxide® Maximum was compared with the data obtained during therapy with Dona, solution for intramuscular administration, in a group of patients with a similar diagnosis according to a standard treatment regimen.

A comprehensive examination was carried out on 40 patients with OA of the knee joints and severe pain syndrome aged from 48 to 75 years (average age - 56.7±8.2 years), of which 38 (95%) were women and 2 (5%) men. All patients had a verified diagnosis of knee OA and gonarthrosis (Altman RD criteria, 1995). The duration of the disease varied from 2 to 15 years (the average “experience” was 6.7±2.9 years). The X-ray stage of gonarthrosis according to Kellegren-Lawrence was determined as II – in 30 (75%) patients, III – in 10 (25%) people.

Concomitant pathologies were identified: arterial hypertension - in 24 (60%), coronary heart disease - in 12 (30%), chronic gastroduodenitis - 28 (70%), varicose veins of the lower extremities - in 22 (55%).

At the time of examination, all 40 (100%) patients were taking nonsteroidal anti-inflammatory drugs (NSAIDs).

The patients were divided into 2 groups of 20 people, comparable in basic parameters. The first group received local Chondroxide® Maximum, 3 cm of cream on the affected joint area up to 3 times a day for a month. The “target” joint was considered to be the joint with maximum pain at the start of the study. The second group received the drug "Dona", intramuscularly, once a day 3 times a week for a month. The effectiveness of therapy was determined according to the dynamics of articular syndrome indicators in the “target” knee joint. The following indicators were assessed: the intensity of pain in the joint at rest and during movement according to VAS, the WOMAC index (dynamics of the total index and individual indicators - pain, stiffness and functional failure of the joint), the need for NSAIDs (ibuprofen). And also, according to the proposed study design, the effectiveness of therapy was assessed according to the patient and doctor (good; satisfactory; no effect; deterioration). These clinical parameters were assessed at the initial examination and weekly for 1 month. In addition, adverse events were monitored during this period. Tolerability of the drug was considered good in the absence of adverse events or their insignificant severity, which did not require a change in the dose of the drug or its discontinuation; satisfactory – in the presence of mild or moderate side effects requiring a reduction in the dose of the drug; unsatisfactory - with significant severity of side effects requiring discontinuation of the drug.

Statistical analysis was carried out using the STATISTICA 6.0 application package (StatSoft, USA). In descriptive statistics, data are presented in the form M±SD, where M is the mean value of the attribute, SD is the standard deviation. To compare two groups on a quantitative basis, Student's t-test was used. Table 1

Clinical characteristics of patients with OA

At the time of inclusion, all patients had severe pain and limited range of motion in the knee joints (Table 2).

The first effect in the form of pain reduction in patients receiving both “Chondroxid® Maximum”, a cream for external use, and “Donu” (i.m.) was registered on days 7-10 from the start of therapy.

After 1 month, therapy in the two groups was effective in all patients. When comparing the WOMAC index in both study groups, the most dynamic was the indicator characterizing the decrease in the severity of pain. During treatment, there was a significant (p<0.05) reduction in pain when walking on level ground, climbing stairs, and joint pain on palpation (Table 2, graph 1, 2). There were no statistically significant differences in the dynamics of indicators between the groups. However, there was a tendency towards a more significant (p=0.06) reduction in pain on palpation during therapy with Chondroxide® Maximum, which is explained by its local application to painful areas; a larger observation group is required to obtain statistical significance (Table 2).

In both groups, a significantly significant (p<0.05) improvement in motor activity was observed, which was expressed in a decrease in the time to cover a distance of 15 meters from 29.6±12.18 to 18±6.1 seconds and from 30.7±12. 21 to 18.25±5.225 seconds in group I and group II, respectively (Table 2).

Similar to the reduction in pain, there was also a decrease in the total WOMAC stiffness index, which reached its maximum values ​​by the 4th visit in both groups (Graph 3). In the Chondroxide® Maximum group, the regression of this indicator by the 4th week of the study was more than 64% (Table 3).

In general, the decrease in the total WOMAC index observed in the Chondroxide® Maximum group by the end of the study was not statistically different from the comparison group and amounted to more than 57% (in the Dona group - more than 56%) (Table 3).

During treatment, in each group there was a clear reduction in the average need for NSAIDs by more than 15 times (Table 2). Thus, during therapy with Chondroxide® Maximum, 15 (75%) people stopped taking ibuprofen, and 5 (25%) reduced the dose by 7-10 times. In the group receiving Dona by injection, after 1 month 16 (80%) patients did not need to take ibuprofen, 4 people reduced the dose by 3-5 times from the original one.

table 2

Dynamics of quantitative indicators of articular syndrome during drug therapy

"Chondroxid® Maximum"
, topically and " Dona", intramuscularly

*-p < 0.05 – significance of differences in indicators in each group before and after treatment

# -р=0.06 – significance of differences in indicators in the group after treatment with
Chondroxide® Maximum, topically and Dona, intramuscularly.
Assessment of therapy effectiveness indicators was carried out at visits 1, 2, 3 and 4. The dynamics of values ​​are presented in graphs (1-4).

Schedule 1

Schedule 2

Schedule 3

Schedule 4

Schedule 5

In general, by the 4th week of observation, the improvement in most indicators of the WOMAC index was more than 50% (54-70%) of the baseline, which corresponds to a good effect of therapy in the two groups (Table 3).

Table 3

Dynamics of quantitative indicators of articular syndrome during therapy with Chondroxide® Maximum, cream for external use,

and “Don”, v/m

The effectiveness of therapy with Chondroxide® Maximum cream was rated by patients as good – 8 (40%), satisfactory – 12 (60%), which is comparable to patients’ assessment of the effectiveness of intramuscular administration of the drug “Dona”: 9 (45%) and 11 (55 %) people noted good and satisfactory effects, respectively (Table 4). When assessing the effectiveness of therapy by a doctor, the results were as follows: good effectiveness was observed in 10 (50%) patients receiving Chondroxide® Maximum and 9 (45%) receiving Dona, satisfactory – in 10 (50%) and 11 (55% ) respectively (Table 5).

Table 4

The effectiveness of therapy with Chondroxide® Maximum, cream for external use, and Dona, intramuscularly, according to the patient

Table 5

The effectiveness of therapy with Chondroxide® Maximum, cream for external use, and Dona, intramuscularly, according to the doctor

Treatment was well tolerated in both groups. No serious adverse events or worsening of concomitant diseases were recorded during therapy. In the Chondroxide® Maximum group, 3 (15%) patients noted satisfactory tolerability, the rest - good (85%). In the group receiving Dona, 1 (5%) patient had slight redness at the injection site, 3 (15%) noted satisfactory tolerability, and the rest (80%) noted good tolerability.

Conclusions.

Based on the observation results, we can conclude that Chondroxide® Maximum, a cream for external use, is an effective drug for the symptomatic treatment of knee OA. The effect of the drug appears on average on the 7-10th day of therapy, and the improvement in most indicators of the WOMAC index, such as pain intensity, morning stiffness, functional joint failure, after 4 weeks from the start of therapy is more than 50%.

A clinical study showed that the drug "Chondroxid® Maximum", a cream for external use, in comparison with injections "Dona", is not statistically different in such indicators as the intensity of pain in the joint at rest and during movement (according to VAS), the WOMAC index (dynamics of the total index and individual indicators - pain, stiffness and functional insufficiency of the joint), which can serve as a conclusion about the comparability of the clinical effects of these drugs.

The pronounced analgesic and anti-inflammatory effect of the drug helps to reduce the clinical manifestations of gonarthrosis and reduce the need for NSAIDs, up to their complete abolition.

The drug "Chondroxid® Maximum", a cream for external use, is safe for long-term use, including in patients with serious concomitant pathologies.

The absence of undesirable effects, good analgesic and anti-inflammatory effects allow us to recommend “Chondroxid® Maximum”, a cream for external use, for medical use in the treatment of knee OA.

Literature

1. Balabanova R. M., Shekshina E. V. Journal “Supplement to the magazine “Health” “For those who treat”, 2005; 3: 32, 37.

2. Nasonova V. A., Folomeeva O. M., Amirdzhanova, V. N. et al. Diseases of the musculoskeletal system and connective tissue in Russia: dynamics of statistical indicators over 5 years (1994-1998). Scientific and practical Rheumatol., 2000, 2, 4-12.

3. Folomeeva O. M., Lobareva L. S., Ushakova M.A. Disability caused by rheumatic diseases among residents of the Russian Federation. Scientific and practical rheumatol., 2001, 1.15-21.

4. Lila A.M. Osteoarthritis of the knee joints: treatment from the standpoint of evidence-based medicine // New St. Petersburg Medical Gazette - 2006. - No. 1 (35). – pp. 38-44.

5. Kovalenko V.N., Bortkevich O.P. Osteoarthritis. Practical guide. – 2nd ed., revised. and additional – K.: Morion, 2005. – 592 p.

6. Jordan KM, Arden NK, Doherty M. Et al. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report or a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESTISIT) // Ann.Rheum.Dis. – 2003. – Vol. 62. –P. 1145-1155.

7. Fidelix TS, Soares B., Fernandas Moca Trevisani V. Diacerein for osteoarthritis (Review). Cochrane Musculoskeletal Group. Edited (no change to conclusions), published in Issue 1,2009.

8. Aleekseevskaya L.I., Arkhangelskaya G.S., Davydova A.F., et al. long-term results of using Structum, (based on materials from a multicenter study) // therapeutic archive. 2003. No. 75. P. 82-86

Author information:

Svetlana Anatolyevna Lapshina, Candidate of Medical Sciences, Assistant of the Department of Hospital Therapy, Kazan State Medical University, Ministry of Health of the Russian Federation

Afanasyeva Marianna Anatolyevna, rheumatologist, Republican Clinical Hospital of the Ministry of Health of the Republic of Tajikistan

Sukhorukova E.V. rheumatologist, Republican Clinical Hospital of the Ministry of Health of the Republic of Tajikistan

Nigmatullina Z.N. - rheumatologist, State Autonomous Institution “City Clinical Hospital No. 7”, Kazan

Mingaleeva G.F. - rheumatologist, State Autonomous Institution “City Clinical Hospital No. 7”, Kazan

Chondroitin or Chondroxide – which is better?

Manufacturer: Vertex (Russia)
Release form: capsules, gels and ointments for external use

Active ingredient: chondroitin sulfate

Both drugs have the same active ingredient and are used for internal and external use in the treatment of joint diseases accompanied by degenerative processes in cartilage tissue. The difference in medications lies in the use of drugs.

Chondroxide can be used by pregnant women, mothers during lactation and children, but with caution. Chondroitin is contraindicated for this category of patients and when breastfeeding.

pharmachologic effect

Manufacturer: Nizhpharm JSC (Russia)
Release form: ointment, gel for external use, tablets, solution in ampoules

Active ingredient: sodium chondroitin sulfate

Chondroxide, available in several dosage forms, stimulates the restoration of the pathologically altered cellular structure of cartilage tissue, stopping unwanted processes in it.

The drug has a combined effect and promotes:

• pain relief;
• slowing down the progression of degenerative processes (osteochondrosis, arthrosis);
• stopping the inflammatory process;
• an increase in the volume of joint fluid;
• relieving joint swelling;
• increasing the range of motion in the joints.

The main active ingredient of the drug is natural chondroitin sulfate, which is involved in the formation of cartilage tissue. This important mucopolysaccharide is involved in biochemical processes and stimulates phosphorus-calcium metabolism in cellular structures.

As a result of this action, there is a decrease in the activity of enzymes, which increase the rate of chemical reactions that destroy cartilage tissue.

Chondroxide - instructions for use

According to the instructions for use , Chondroxide is prescribed as internal, external or parenteral administration of the drug in the following dosage:

• Ointment or gel - it is recommended to apply to the skin over the affected area of ​​the joint or vertebral joints 2-3 times a day. The ointment is applied to the skin with light massage movements until it is completely absorbed, and the gel is applied with patting movements for 2-3 minutes. The duration of treatment is 2–3 weeks.
• Tablets of 250 mg - prescribed 2 pieces 2 times a day for 3-6 months. According to indications, after a break the course of treatment is repeated.
• Ampoules of 1 or 2 ml (1 ml contains 100 mg of active substance) - intramuscular administration of the drug is recommended, 1 ml (100 mg) every other day. The dose can be increased to 200 mg, if the drug is well tolerated and according to indications, but after 4 injections. The course of treatment is 25–35 injections, which can be repeated after 6 months.

In the pharmacy chain, Chondroxide ointment and gel are available without a prescription, and the injectable drug is available only with a doctor’s prescription.