Chondroitin sulphate and glucosamine use depend on non-steroidal anti-inflammatory drugs use to modify the risk for colorectal cancer

Background: A safe and effective colorectal cancer (CRC) chemoprevention agent remains to be discovered. There is little evidence regarding the protective effect of chondroitin sulphate and glucosamine on CRC. We aimed to assess the association between CRC risk and the use of chondroitin sulphate and glucosamine using a large cohort with dispensed data.

Methods: We performed a population-based case-control study in Catalonia using primary care reimbursed medication records (SIDIAP database). The study included 25,811 cases with an incident diagnosis of CRC and 129,117 matched controls between 2010 and 2015.

Results: The prevalence of ever use was 9.0% (n=13,878) for chondroitin sulphate, 7.3% (n=11,374) for glucosamine and 35% for regular use of NSAID (n=45,774). A decreased risk of CRC was observed among chondroitin sulphate (OR: 0.96, 95%CI 0.91-1.01), glucosamine users (OR: 0.92, 95%CI 0.87-0.97), and concurrent use of chondroitin sulphate and glucosamine (OR: 0.83, 95% CI: 0.70-0.98). Especially for glucosamine, there was a dose-response association regarding duration and cumulative dose. The analysis stratified by simultaneous use with NSAIDs showed that these drugs used without NSAIDs do not reduce risk (OR: 1.06, 95%CI 0.74-1.51). However, they may have a synergistic protective effect when used with other NSAIDs (OR=0.80, 95%CI: 0.72-0.88).

Conclusion: This study does not provide strong support for an independent protective association of chondroitin sulphate or glucosamine on CRC risk in our population. However, these drugs may have a synergistic beneficial effect among NSAIDs users.

Impact: chondroitin sulphate or glucosamine may contribute to the protective effect of NSAID use in CRC.