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

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.

• Authors: Karel Pavelka, Olivier Bruyère, Cyrus Cooper, John A Kanis, Burkhard F Leeb, Emmanuel Maheu, Johanne Martel-Pelletier, Jordi Monfort, Jean-Pierre Pelletier, René Rizzoli, Jean-Yves Reginster
• Journal: Drugs & aging (Drugs Aging) Vol. 33 Issue 2 Pg. 75-85 (Feb 2016) ISSN: 1179-1969 [Electronic] New Zealand
• PMID: 26849131 (Publication Type: Journal Article, Review)

Chemical References

• Anthraquinones
• Anti-Inflammatory Agents
• Delayed-Action Preparations
• diacerein

Topics

• Anthraquinones (pharmacology)
• Anti-Inflammatory Agents (pharmacology)
• Bone Remodeling (drug effects)
• Delayed-Action Preparations (pharmacology)
• Humans
• Osteoarthritis (drug therapy, physiopathology)
• Pharmacovigilance
• Risk Assessment