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.

2nd Department of Medicine State Hospital Stockerau Centre for Rheumatology Lower Austria Karl Landsteiner Institute for Clinical Rheumatology Stockerau Austria

Department of Public Health Epidemiology and Health Economics University of Liège Liège Belgium

Division of Bone Diseases Geneva University Hospital and Faculty of Medicine Geneva Switzerland

Institute of Rheumatology and Clinic of Rheumatology Charles University Prague Czech Republic

MRC Lifecourse Epidemiology Unit and NIHR Nutrition Biomedical Research Centre University of Southampton Southampton UK

Osteoarthritis Research Unit University of Montreal Hospital Research Centre Notre Dame Hospital Montreal Canada

Rheumatology Department AP HP St Antoine Hospital Paris France

Rheumatology Service Hospital del Mar Universitat Autònoma de Barcelona Barcelona Spain

WHO Collaborating Centre for Metabolic Bone Diseases University of Sheffield Medical School Sheffield UK

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