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Drugs Aging. 2016 Feb;33(2):75-85. doi: 10.1007/s40266-016-0347-4.

Diacerein: Benefits, Risks and Place in the Management of Osteoarthritis. An Opinion-Based Report from the ESCEO.

Author information

1
Institute of Rheumatology and Clinic of Rheumatology, Charles University, Prague, Czech Republic.
2
Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium. olivier.bruyere@ulg.ac.be.
3
MRC Lifecourse Epidemiology Unit and NIHR Nutrition Biomedical Research Centre, University of Southampton, Southampton, UK.
4
WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK.
5
2nd Department of Medicine, State Hospital Stockerau, Centre for Rheumatology, Lower Austria, Karl Landsteiner Institute for Clinical Rheumatology, Stockerau, Austria.
6
Rheumatology Department, AP-HP, St-Antoine Hospital, Paris, France.
7
Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Notre-Dame-Hospital, Montreal, Canada.
8
Rheumatology Service, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
9
Division of Bone Diseases, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland.
10
Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.

Abstract

Diacerein is a symptomatic slow-acting drug in osteoarthritis (SYSADOA) with anti-inflammatory, anti-catabolic and pro-anabolic properties on cartilage and synovial membrane. It has also recently been shown to have protective effects against subchondral bone remodelling. Following the end of the revision procedure by the Pharmacovigilance Risk Assessment Committee of the European Medicines Agency, the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) constituted a panel of 11 experts to better define the real place of diacerein in the armamentarium for treating OA. Based on a literature review of clinical trials and meta-analyses, the ESCEO confirms that the efficacy of diacerein is similar to that of non-steroidal anti-inflammatory drugs (NSAIDs) after the first month of treatment, and superior to that of paracetamol. Additionally, diacerein has shown a prolonged effect on symptoms of several months once treatment was stopped. The use of diacerein is associated with common gastrointestinal disorders such as soft stools and diarrhoea, common mild skin reactions, and, uncommonly, hepatobiliary disorders. However, NSAIDs and paracetamol are known to cause potentially severe hepatic, gastrointestinal, renal, cutaneous and cardiovascular reactions. Therefore, the ESCEO concludes that the benefit-risk balance of diacerein remains positive in the symptomatic treatment of hip and knee osteoarthritis. Furthermore, similarly to other SYSADOAs, the ESCEO positions diacerein as a first-line pharmacological background treatment of osteoarthritis, particularly for patients in whom NSAIDs or paracetamol are contraindicated.

PMID:
26849131
PMCID:
PMC4756045
DOI:
10.1007/s40266-016-0347-4
[Indexed for MEDLINE]
Free PMC Article

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