Can Diacerein Act as a Disease-Modifier for Osteoarthritis?

Diacerein Still Unproven, Now Restricted in the European Union

An elderly woman suffering from joint pain.
An elderly woman suffering from joint pain.. Jose Luis Pelaez Inc/Getty Images

Diacerein has been studied in hopes it would be able to slow the progression of osteoarthritis. Disease-modifying drugs are known treatment options for rheumatoid arthritis and other inflammatory types of arthritis. But drugs that could modify the progression of osteoarthritis, slowing joint damage and decreasing the chance of disability remain unproven. Diacerein has yet to show that the risks outweigh its benefits.

Usual Osteoarthritis Treatments Don't Slow Disease Progression

The usually recommended non-drug treatments for knee osteoarthritis and hip osteoarthritis -- two of the joints most affected by osteoarthritis -- include weight loss, exercise, and avoidance of weight-bearing activities that increase stress to the joints.

Drugs and supplements used to treat osteoarthritis include adequate vitamin D intake; analgesics such as Tylenol; NSAIDs (nonsteroidal anti-inflammatory drugs) such as naproxen and ibuprofen; supplements such as glucosamine sulfate; and joint injections. Alternative therapies are also among popular treatment options. Other than weight loss, there has been no conclusive evidence that these treatment regimens slow down or prevent osteoarthritis.

Diacerein Is Being Studied as Disease-Modifier for Osteoarthritis

Diacerein has been studied to treat osteoarthritis of the knees and hips.

Diacerein is an anti-inflammatory medication that works differently from the typical NSAIDS. Diacerein blocks interleukin-1, as opposed to inhibiting the cyclooxygenase (COX) pathway as NSAIDs do.

In studies, diacerein was typically prescribed at a dose of 50 mg twice a day. A review of 7 clinical studies involving diacerein, which included 2,069 patients, was published by The Cochrane Collaboration in 2006.

It concluded that diacerein had a small effect in improving pain and slowing the progression of osteoarthritis compared to standard treatment with NSAIDs or placebo. The most common side effect associated with diacerein was diarrhea.

The Cochrane Collaboration updated their systematic review in 2013, adding three new trials of 141 participants. With the new evidence, they confirmed that the strength of evidence for effectiveness outcomes was low to moderate, and pain reduction was minimal. In osteoarthritis of the hip, there was a small benefit for reducing joint space narrowing, but it was probably not clinically relevant. There is a 24% risk of diarrhea with diacerein.

European Medicines Agency Restricts Use of Diacerein in the European Union - 2014

On March 19, 2014, the Co-ordination Group for Mutual Recognition and Decentralised Procedures - Human (CMDh) endorsed restricting diacerein in the European Union, It became legally binding on September 4, 2014. The reasons cited were the risk of severe diarrhea and effects on the liver.

More Studies Needed for Diacerein

We asked rheumatologist Scott J. Zashin, MD about diacerein for osteoarthritis. Dr. Zashin said, "At this time, there is no definitive evidence that diacerein produces significant results as a disease-modifying drug for osteoarthritis. Further study is needed to establish the short and long-term safety and effectiveness of diacerein for osteoarthritis."

The drug is not available in the United States, the European Union, Canada, Britain, or Australia. It may be available in a few countries, subject to further regulation. The decision of the European Union to restrict it in 2014 is a judgment that the evidence is conclusive enough that the risks outweigh the benefits.

Sources:

Fidelix TS, Soares BG, Trevisani VF. "Diacerein for osteoarthritis." Cochrane Database Syst Rev. 2006 Jan 25;(1):CD005117.

Fidelix TS, Macedo CR, Maxwell LJ, Fernandes Moça Trevisani V."Diacerein for osteoarthritis." Cochrane Database Syst Rev. 2014 Feb 10;2:CD005117. doi: 10.1002/14651858.CD005117.pub3.

Scott J. Zashin MD is clinical assistant professor at University of Texas Southwestern Medical School and an attending physician at Presbyterian Hospitals of Dallas and Plano. Dr. Zashin is author of Arthritis Without Pain - The Miracle of TNF Blockers. The book is useful for anyone on one of the biologic drugs or considering the biologic drugs.

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