As it turns out, Diacerein (drug name), or Cartidin (Brand name) and ART 50 (trade name Artrodar), is still on the market in many countries, but never was available in the U.S.. As discovered in one of the articles we read last week, Diacerein, a drug used as a therapeutic agent in osteoarthritis, blocks Interleukin-1, as opposed to inhibiting the cylcooxygenase (COX) pathway, interfering with prostaglandin synthesis as NSAIDS do. After more research, I continued to find that in all of the clinical studies I read about, Diacerein had a reasonable safety profile and efficacy. It seems as if Diacerein may be more tolerable in patients and may have some advantages compared with the medium to long term use of NSAIDS, which pose a risk of several more severe negative side effects, such as gastrointestinal and cardiovascular events. In France, from 1994 to 2005 and after more than 14 million prescriptions of Diacerein, only nine cases of cardiovascular adverse events were reported (Bukharb Leeb, European Musculoskeletal Review, 2010;5(1):23-29). Up to 42% of treated patients in clinical trials reported diarrhea or loose stools and darker urine, which most commonly appeared during the first two weeks of treatment, but is found tolerable at the level of the kidney. 18% of these patients withdrew from these side effects and 13% of patients given placebo did as well. What gives?
Although most evidence is derived from the hip joint, Diacerein has consistently shown a positive effect on pain and function in patients with hip and knee OA through majority of clinical trials and metaanalysis. It seems to be a rational therapeutic option in OA patients and in general, plays a key role as a mediator in the inflammatory processes. It would be nice to see further research and more long term studies on individuals sufferring from OA, not just in the hip or knee joints, but in other areas to fully understand the effects of Diacerein and solidify the hypotheses presented. Perhaps one day it will become FDA approved and favored over NSAIDS in the U.S..
To read more about this and a summary of the many studies done involving patients treated with Diacerein, please check out this very informative review I found:
http://www.touchmusculoskeletal.com/articles/clinical-efficacy-and-safety-diacerein-osteoarthritis-review?page=0,4
After reading this, I was interested in knowing why certain subjects withdrew from this study and what may have caused these negative symptoms (diarrhea, darker urine). While doing some research, I came across this study that was talking about the efficacy of diacerein in patients suffering from osteoarthritis of the knee. It looks like they have determined an exact dosage (50 mg twice/day) of diacerein that is optimal in treating these patients. What I found really interesting was that subjects who were taking 150 mg per day ended up having to withdraw from the study due to adverse effects. It's crazy how a drug that generally shows favorable results can be unfavorable with the difference of 50 mg. Anyways, here's the link: http://www.ncbi.nlm.nih.gov/pubmed/11037895
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