title: Efficacy and safety of glucosamine, diacerein, and NSAIDs in osteoarthritis knee: a systematic review and network meta-analysis.
abstract: BACKGROUND
  To conduct a systematic review and network meta-analysis of randomized controlled trials (RCTs) with the aims of comparing relevant clinical outcomes (that is, visual analog scores (VAS), total and sub-Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) scores, Lequesne algofunctional index, joint space width change, and adverse events) between diacerein, glucosamine, and placebo.
  
  
  METHODS
  Medline and Scopus databases were searched from inception to 29 August 2014, using PubMed and Scopus search engines and included RCTs or quasi-experimental designs comparing clinical outcomes between treatments. Data were extracted from original studies. A network meta-analysis was performed by applying weight regression for continuous outcomes and a mixed-effect Poisson regression for dichotomous outcomes.
  
  
  RESULTS
  Thirty-one of 505 identified studies were eligible. Compared to placebo, glucosamine showed a significant improvement with unstandardized mean differences (UMD) in total WOMAC, pain WOMAC, function WOMAC, and Lequesne score of -2.49 (95% confidence interval (CI) -4.14, -0.83), -0.75 (95% CI: -1.18, -0.32), -4.78 (95% CI: -5.96, -3.59), and -1.03 (95% CI: -1.34, -0.72), respectively. Diacerein clinically improves visual analog scores, function WOMAC, and stiffness WOMAC with UMD values of -2.23 (95% CI: -2.82, -1.64), -6.64 (95% CI: -10.50, -2.78), and -0.68 (95% CI: -1.20, -0.16) when compared to placebo.
  
  
  CONCLUSIONS
  The network meta-analysis suggests that diacerein and glucosamine are equally efficacious for symptom relief in knee OA, but that the former has more side effects.
authors.affiliation: Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Faculty of Medicine Ramathibodi Hospital, Ratchathewi, Chang Wat Bangkok, Bangkok, 10400, Thailand. Jatupon_kong@hotmail.com.
authors.forename: Jatupon
authors.initials: J
authors.lastname: Kongtharvonskul
authors.affiliation: Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Faculty of Medicine Ramathibodi Hospital, Ratchathewi, Chang Wat Bangkok, Bangkok, 10400, Thailand. ratan@mahidol.ac.th.
authors.forename: Thunyarat
authors.initials: T
authors.lastname: Anothaisintawee
authors.affiliation: Centre for Clinical Epidemiology and Biostatistics, The University of Newcastle, University Drive, Newcastle, NSW 2308, Australia. McEvoy@newctle.edu.au.
authors.forename: Mark
authors.initials: M
authors.lastname: McEvoy
authors.affiliation: Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, University Drive, Newcastle, NSW 2308, Australia. john.attia@newcastle.edu.au.
authors.forename: John
authors.initials: J
authors.lastname: Attia
authors.affiliation: Department of Orthopaedics, Faculty of Medicine Ramathibodi Hospital, Bangkok, Mahidol University, Highway 3310, Bangkok, 73170, Thailand. patarawan.wor@mahidol.ac.th.
authors.forename: Patarawan
authors.initials: P
authors.lastname: Woratanarat
authors.affiliation: Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Faculty of Medicine Ramathibodi Hospital, Ratchathewi, Chang Wat Bangkok, Bangkok, 10400, Thailand. ammarin.tha@mahidol.ac.th.
authors.forename: Ammarin
authors.initials: A
authors.lastname: Thakkinstian
mesh_terms: D000880:Anthraquinones / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D005944:Glucosamine / Q000627:therapeutic use*; D006801:Humans; D020370:Osteoarthritis, Knee / Q000188:drug therapy*
chemical_list: D000880:Anthraquinones; D000894:Anti-Inflammatory Agents, Non-Steroidal; C025292:diacerein; D005944:Glucosamine