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Does diacerein work for OA?

Diacerein acts differently from traditional NSAIDs which inhibit prostaglandin syn-thesis, leading to adverse gastrointestinal effects. It is not clear whether diacerein works and whether it is safer than other drugs used to treat OA.

Method

Seven studies of moderate to high quality were reviewed and provide the best evidence we have today. The studies tested more than 2,000 people with osteoarthritis of the hip or knee and compared people who took 100mg of diacerein with people who took a placebo or NSAIDs or other slow-acting arthritis drugs. The studies lasted two months to three years.

Main results

Pain improved about the same whether people took diacerein, a placebo, NSAIDs or other slow-acting drugs. But, pain does seem to improve a bit more in people who take diacerein.

Pain decreased by about five more points on a 0-100 scale for people who took dia-cerein rather than a placebo.One study shows that pain, stiffness, and physical function overall improved more in people who took diacerein than a placebo.Two long-term studies which lasted one year and three years measured the progress of the disease on X-rays. The studies found diacerein slowed the progress in OA of the hip more than a placebo but did not slow the progress in OA of the knee.Side-effects included diarrhoea, heartburn, soft stools, stomach pain and frequent bowel movements. Diarrhoea was the most common side-effect and usually occurred during the first two weeks of starting diacerein.Of 100 people who took diacerein, 42 had diarrhoea, and 18 withdrew from the studies due to side-effects compared with 13 out of 100 people in the placebo group.

Authors' conclusionsThe level of quality of the evidence is 'gold'. It appears diacerein has a small effect in improving pain and slowing the progress of osteoarthritis (in the hip). Diarrhoea is a common side-effect of diacerein. Longer studies need to be done to determine the long-term benefits and harms of diacerein.Fidelix TSA et al. Diacerein for OA, The Cochrane Database of Systematic Reviews, 2006, issue 1

The Cochrane Library www.thecochranelibrary.com contains high-quality information about the effects of health care from the Cochrane Collaboration (www.cochrane.org), a UK-registered international charity and the world's leading producer of systematic reviews.UK residents are able to access the Cochrane Library free. To gain maximum benefit, ie download PDFs, log on to www.thecochranelibrary.com and click on 'Do you already have access?' to enter via the host site for your particular country.Guest users may access abstracts for all reviews in the database. For further information, contact adugan@wiley.co.uk

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