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

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