Evaluation of the effectiveness and tolerability of diacerein in patients with osteoarthritis of the knee and hip joints

Aim: to evaluate the effectiveness and tolerability of the domestic drug Diacerein-SZ in patients with osteoarthritis of the knee and hip joints.

Patients and Methods. A single-center clinical prospective study was conducted, which included patients with osteoatritis and metabolic syndrome. 65 patient with OA of the knee and/or hip joints of stage II–III according to Kellgren–Lawrence with pain intensity >30 mm on a visual analog scale, aged 40 to 71 years, was examined. The duration of therapy was 6 months: 1 month – taking the drug Diacerein-SZ at a dose of 50 mg/day, then 5 months at 50 mg 2 times a day. During each visit, pain syndrome (VAS, mm), BMI, and biochemical blood tests were assessed. Data on the use of additional drugs with anti-inflammatory effects, as well as adverse events, were analyzed.

Results. The average age of patients was 55.5 [49.5; 58] years. A pronounced anti-inflammatory effect was noted in the form of a decrease in the level of VAS and CRP (p <0.0001), which led to the complete abolition of NSAIDs by the end of the study in 67.7% of the subjects. A statistically significant decrease in uric acid and glycated hemoglobin was observed already by week 12 of the study (p = 0.011), (p = 0.0001), respectively. There were no significant differences in lipid profile and glucose levels (p >0.05). Adverse events were recorded in 12.9% of patients.

Conclusion. The use of the domestic drug Diacerein-SZ in patients with osteoarthritis led to a decrease in the need for NSAIDs, had a favorable effect profile on the level of uric acid and glycated hemoglobin, and was well tolerated.

1. Alekseeva L.I. Osteoarthritis: epidemiology, classification, risk and progression factors, clinical features, diagnostics, treatment / L.I. Alekseeva, E.A. Taskina, N.G. Kashevarova. Modern rheumatology. 2019; 13 (2): 9-21. (In Russ.).

2. Steinmetz J.D. et al. Global, regional, and national burden of osteoarthritis, 1990–2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021 / J.D. Steinmetz, G. T. Culbreth, L.M. Haile, Q. Rafferty [et al.]. The Lancet Rheumatology. 2023; 5 (9): e508–e522.

3. World Health Organization et al. World Report on Ageing and Health. 2015.

4. Lila A.M. Osteoarthritis vs. osteoarthrosis: a look into the future / A.M. Lila. Opinion Leader. 2019; 9: 30-36. (In Russ.).

5. Muckelt P.E. Comorbidities and their link with individual health status: A cross-sectional analysis of 23,892 people with knee and hip osteoarthritis from primary care / P.E. Muckelt, E.M. Roos, M. Stokes, S. McDonough [et al.]. Journal of Comorbidity. 2020; 10:2235042X20920456.

6. Mazurov V.I. Multimorbidity in osteoarthritis and pleiotropic effects of symptomatic slow-acting agents. Resolution of the international multidisciplinary expert council / V.I. Mazurov, A.M. Lila, L.I. Alekseeva, Ch. Baimukhamedov [et al.]. Modern rheumatology. 2023; 17 (5): 123-131. (In Russ.).

7. Jamal N. Unravelling the ties that bind: The intersection of obesity, osteoarthritis, and inflammatory pathways with emphasis on glucagon-like peptide-1 agonists / N. Jamal, W. Hollabaugh, L. Scott, S. Takkouche. Clinical Obesity. 2024: e12700.

8. Matthews G.L. Emerging drugs for osteoarthritis / G.L. Matthews, D.J. Hunter. Expert opinion on emerging drugs. 2011; 16 (3): 479-491.

9. Satybaldyev A.M. Use of NSAIDs in an elderly patient with acute and chronic pain. Clin. Gerontol. 2020; 26 (5-6): 49-57. (In Russ.).

10. Karateev D.E. Optimal choice of osteoarthritis therapy in comorbid patients / D.E. Karateev, E.L. Luchikhina. Opinion Leader. 2021; 42 (1): 36-40. (In Russ.).

11. Abdel-Gaber S. A. Mechanism mediating the protective effect of diacerein in ischemia-reperfusion-induced testicular injury in rats / S.A. Abdel-Gaber, R.K. Mohammed, M.M.M. Refaie. Life Sciences. 2018; 209: 57-62.

12. Lila A.M. Diacerein in the treatment of osteoarthritis of the knee joints: results of a comparative study / A.M. Lila, L.V. Martynova, V.A. Lila. RMJ. Rheumatology. 2016; 24 (2): 70-77. (In Russ.).

13. Steinecker-Frohnwieser B. The disease modifying osteoarthritis drug diacerein is able to antagonize pro inflammatory state of chondrocytes under mild mechanical stimuli / B. Steinecker-Frohnwieser L. Weigl, W. Kullich, B. Lohberger. Osteoarthritis and Cartilage. 2014; 22 (7): 1044-1052.

14. Liu J. Rhein protects pancreatic β-cells from dynamin-related protein1–mediated mitochondrial fission and cell apoptosis under hyperglycemia / J. Liu, Z. Chen, Y. Zhang, M. Zhang [et al.]. Diabetes. 2013; 62 (11): 3927-3935.

15. Belyaeva I.B. Pleiotropic effects of diacerein in comorbid patients with osteoarthritis / I.B. Belyaeva, V.I. Mazurov. Sovremennaya Revmatologiya. 2022; 16 (4): 98-104. (In Russ.).

16. Altman R. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip / R. Altman, G. Alarcon, D. Appelrouth, D. Bloch. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology. 1991; 34 (5): 505-514.

17. Karateev A.E. Evaluation of diacerein tolerability in real clinical practice. Results of the ROKADA study (Retrospective Evaluation of Clinical Aspects of Diaflex Use in Osteoarthritis) / A.E. Karateev, L.I. Alekseeva. Scientific and Practical Rheumatology. 2015; 53 (2): 169-174. (In Russ.).

18. Naumov A.V. Recommended therapy for osteoarthritis: new solutions to old problems / A.V. Naumov, N.O. Khovassova. RMJ. Medical Review. 2016; 24 (3): 197-202. (In Russ.).

19. Cardoso C.R.L. Efficacy and safety of diacerein in patients with inadequately controlled type 2 diabetes: a randomized controlled trial / C.R.L. Cardoso, N.C. Leite, F.O. Carlos, A.A. Loureiro [et al.]. Diabetes Care. 2017; 40 (10): 1356-1363.

20. Alekseeva L.I. Osteoarthritis of the knee joints and metabolic syndrome: new approaches to therapy / L.I. Alekseeva, E.A. Taskina, N.G. Kashevarova, E.P. Sharapova [and others]. Scientific and practical rheumatology. 2018; 56 (2): 157-163. (In Russ.).