In a prospective, randomized, 6-month, 3-arm, double-blind, crossover trial, placebo was compared to Chondroitin Sulfate (800mg/day) and celecoxib (200mg/day). The changes in pain on a Visual Analogue Scale (VAS), and in the Lequesne Index (LI) were assessed as co-primary endpoints. Secondary endpoints of Minimal-Clinically Important Improvement (MCII) and Patient-Acceptable Symptoms State (PASS) were used. 604 patients diagnosed with knee osteoarthritis, according to American College of Rheumalogy (ACR) criteria, were recruited in five European countries, and followed for 182 days. CS and celecoxib showed a greater significant reduction in pain and LI than placebo. Pain reduction in VAS at day 182 in the CS group (−42.6mm) and in celecoxib group (−39.5mm) was significantly greater than the placebo group. [(−33.3mm) (p=0.001 for CS and p=0.009 for celecoxib)]. The LI demonstrated a similar trend. No difference was observed between CS and celecoxib. At the 182 day mark, “both secondary endpoints (MCII and PASS) improved significantly in the CS and celecoxib groups. All treatments demonstrated excellent safety profiles. The study concluded in stating, “800 mg/day pharmaceutical-grade CS is superior to placebo and similar to celecoxib in reducing pain and improving function over 6 months in symptomatic knee osteoarthritis (OA) patients. This formulation of CS should be considered a first-line treatment in the medical management of knee OA.”\r\n\r\nReginster J, Dudler J, Blicharski T, Pavelka P. Pharmaceutical-grade Chondroitin sulfate is as effective as celecoxib and superior to placebo in symptomatic knee osteoarthritis: the Chondroitin versus Celecoxib versus Placebo Trial (CONCEPT) Annals of the Rheumatic Diseases Published Online First: 22 May 2017. doi: 10.1136/annrheumdis-2016-210860.