title: 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: Institute of Rheumatology and Clinic of Rheumatology, Charles University, Prague, Czech Republic.
authors: Karel
authors: K
authors: Pavelka
authors: Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium. olivier.bruyere@ulg.ac.be.
authors: Olivier
authors: O
authors: Bruyère
authors: MRC Lifecourse Epidemiology Unit and NIHR Nutrition Biomedical Research Centre, University of Southampton, Southampton, UK.
authors: Cyrus
authors: C
authors: Cooper
authors: WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK.
authors: John A
authors: JA
authors: Kanis
authors: 2nd Department of Medicine, State Hospital Stockerau, Centre for Rheumatology, Lower Austria, Karl Landsteiner Institute for Clinical Rheumatology, Stockerau, Austria.
authors: Burkhard F
authors: BF
authors: Leeb
authors: Rheumatology Department, AP-HP, St-Antoine Hospital, Paris, France.
authors: Emmanuel
authors: E
authors: Maheu
authors: Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Notre-Dame-Hospital, Montreal, Canada.
authors: Johanne
authors: J
authors: Martel-Pelletier
authors: Rheumatology Service, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors: Jordi
authors: J
authors: Monfort
authors: Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Notre-Dame-Hospital, Montreal, Canada.
authors: Jean-Pierre
authors: JP
authors: Pelletier
authors: Division of Bone Diseases, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland.
authors: René
authors: R
authors: Rizzoli
authors: Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
authors: Jean-Yves
authors: JY
authors: Reginster
mesh_terms: D000880:Anthraquinones / Q000494:pharmacology*; D000893:Anti-Inflammatory Agents / Q000494:pharmacology; D016723:Bone Remodeling / Q000187:drug effects*; D003692:Delayed-Action Preparations / Q000494:pharmacology; D006801:Humans; D010003:Osteoarthritis / Q000188:drug therapy / Q000503:physiopathology; D060735:Pharmacovigilance; D018570:Risk Assessment
chemical_list: D000880:Anthraquinones; D000893:Anti-Inflammatory Agents; D003692:Delayed-Action Preparations; C025292:diacerein