Diacerein has advantages over placebo and nonsteroidal anti-inflammatory drugs in treating hip and knee osteoarthritis, according to a new meta-analysis.
Diacerein is a member of the symptomatic slow-acting drugs in osteoarthritis group. They are of interest because they reduce cartilage degradation while improving symptoms. They tend to start working slowly, but they have a prolonged residual effect after treatment is stopped.
For the meta-analysis, published in the Sept. 25, 2006, issue of Archives of Internal Medicine, Dr. Bernhard Rintelen and colleagues from the Lower Austrian Center for Rheumatology, Stockerau, Austria, analyzed 19 randomized controlled trials involving a total of 2,637 patients (Arch. Intern. Med. 2006;166:1899–906).
Eight of the trials were placebo controlled, while 11 had active controls, which mainly compared diacerein with nonsteroidal anti-inflammatory drugs (NSAIDs).
During the active treatment phase, diacerein was significantly superior to placebo in reducing pain and improving function, with a Glass score (standardized mean difference) of 1.50, the authors wrote. NSAIDs showed similar efficacy to diacerein during active treatment, but at treatment end, diacerein's efficacy lasted up to 3 months longer, whereas NSAIDs did not (Glass score of 2.06).
Diacerein seemed well tolerated, even after long-term use. The most common adverse event was mild to moderate diarrhea, starting in early treatment and resolving during continuing therapy. The only other frequent adverse event was darker-than-normal urine, which had no clinical significance. There were no statistically significant differences between diacerein and NSAIDs in tolerability, though patients taking NSAIDs had a greater number of severe events. Diacerein is marketed as Artrodar in India, Europe, and Latin America. It is not yet available in the United States.