Diacerein versus non-steroidal anti-inflammatory drugs in the treatment of knee osteoarthritis: a meta-analysis

Abstract

Background Knee osteoarthritis (KOA) is a common musculoskeletal condition affecting millions of people worldwide and posing a significant challenge to clinicians and researchers. Emerging evidence suggests that the multifaceted symptomatology of KOA may be alleviated by diacerein. With this in mind, we conducted a systematic review and meta-analysis to evaluate the efficacy and safety of diacerein in patients with KOA. Methods We systematically searched Embase, PubMed, Cochrane Library, Web of Science, Chinese Biomedical Literature Database (CBM), Wanfang Database (WanFang), China National Knowledge Infrastructure (CNKI), and China Science and Technology Journal Database (VIP) from their inception to August 2022 for randomized controlled trials (RCTs) of diacerein intervention on patients with KOA. Two reviewers independently performed the selection of eligible studies and the extraction of relevant data. The meta-analysis was performed using RevMan 5.4 and R 4.1.3 software tools. Depending on the type of outcome indicator selected, summary measures were expressed as mean differences (MD), standardized mean differences (SMD), or odds ratio (OR) with 95% confidence intervals (CI). Results Twelve RCTs with 1732 patients were included. The results revealed that diacerein had comparable efficacy to non-steroidal anti-inflammatory drugs (NSAIDs) in reducing pain indicators such as Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (SMD = 0.09, 95% CI [−0.10, 0.28], P = 0.34) and visual analogue scale (VAS) (SMD = −0.19, 95% CI [−0.65, 0.27], P = 0.42). However, diacerein outperformed NSAIDs in terms of global efficacy assessment by both patients and investigators (patients: 1.97, 95% CI [1.18, 3.29], P = 0.01; investigator: 2.18, 95% CI [0.99, 4.81], P = 0.05) at the end of treatment and sustained effectiveness in reducing WOMAC score and VAS score at four weeks after treatment. Moreover, there was no significant difference in adverse events incidence between the diacerein and NSAID groups. However, the GRADE evaluation indicated that the majority of the evidence quality was low. Conclusions The results of this study suggest that diacerein could potentially be considered as a pharmacological agent with significant efficacy for the treatment of patients suffering from KOA, offering a potential alternative treatment strategy for those patients contraindicated to NSAIDs. However, further high-quality studies with longer follow-up are needed to make more informed decisions about its efficacy in the treatment of KOA.

The Analysis Study of Association of Pharmacological Treatments With Long-Term Pain Control in Patients With Knee Osteoarthritis : A Comprehensive Systematic Review

“…Furthermore, the study revealed that diacerein outperformed NSAIDs in enhancing WOMAC and VAS scores during the follow-up period after the treatment, suggesting a stronger long-term effect. 19 KOA is predominantly characterized by cartilage degeneration, with pro-inflammatory cytokines playing a pivotal role in the development of the condition. 26 Diacerein, an anthraquinone derivative, functions by inhibiting the IL-1 system and its associated downstream signaling pathways, leading to the reduction of IL-1β activation and promoting cartilage repair.…”

“…The incidence of adverse events associated with diacerein was similar to that of NSAIDs, indicating a favorable safety profile. 19 A study conducted a meta-analysis of the use of traditional Chinese herbal medicine in treating knee osteoarthritis patients. The analysis included 56 high-quality randomized controlled trials (RCTs) involving 5350 patients.…”

Efficacy and safety of diacerein and celecoxib combination therapy for knee osteoarthritis: A double-blind, randomized, placebo-controlled prospective study

“…[ 2 ] Several studies on the comparative efficacy, safety, and effects of diacerein and celecoxib on osteoarthritis have been published; the corresponding results indicated that diacerein is an effective treatment for osteoarthritis. [ 3 , 4 ] Nonetheless, in clinics, NSAID and diacerein combination therapy is frequently prescribed despite there being few studies comparing the efficacy and safety of NSAID and diacerein combination therapy. Additionally, the studies that have been conducted failed to include a placebo.…”