COMPARATIVE ANALYSIS OF EFFICACY AND SAFETY OF DIACEREIN VERSUS S-ADENOSYL METHIONINE IN THE MANAGEMENT OF OSTEOARTHRITIS OF KNEE JOINT
Keywords:Osteoarthritis, Diacerein, S-adenosyl methionine, Diclofenac
AbstractObjective: Osteoarthritis (OA) the most common type of arthritis is a degenerative joint disease primarily affecting the articular cartilage and its surrounding tissue. Drugs like Diacerein and S-adenosyl methionine (SAMe) are used to remodel the cartilage and slow the progression of the disease, by acting through different mechanisms. Though there is documented evidence of the efficacy of both agents used individually in several clinical trials only a few studies report a comparison. To analyse the efficacy and safety of Diacerein Versus S-adenosyl methionine in the treatment of Osteoarthritis of knee joint.Methods: A prospective randomised interventional study was planned comparing diacerein with SAMe for 12 w in the management of OA of the knee. 40 patients in each group were randomly assigned to receive either diacerein 50 mg twice daily or S-adenosyl methionine 200 mg thrice daily for 12 w. Both groups received a short course of diclofenac 50 mg bd for one week, to tide over the acute symptoms.Results: Assessment of both drugs individually showed an equieffective potential in reducing osteoarthritis pain over a period of 12 w. But the comparison between the two groups showed a marginal improvement in pain relief from the 4th to 12th week of assessment in the diacerein group.Conclusion: Both the drugs for the treatment of OA, were shown to be effective in relieving pain but with a slower onset of action. Since no radiological changes were observed during the 12-week protocol, studies of longer duration are needed to evaluate the long-term effectiveness of these drugs.
Lawerence RC, Helmick CG, Arnett FC, Deyo RA, Felson DT, Giannini EH, et al. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum 1998;41:778-99.
ACR Subcommittee on Osteoarthritis Guidelines. Recommendations for the medical management of osteoarthritis of the hip and knee. Arthritis Rheum 2000;43:1905-15.
Felson DT, Chassion CE, Hill CL, Totterman SMS, Gale ME, Skinner KM, et al. The association of bone marrow lesions with pain in knee osteoarthritis. Ann Int Med 2001;134:541-9.
Aggarwal V. Prevalence of rheumatic diseases in India. J K Sci 2003;5:48-9.
Arden N, Nevitt MC. Osteoarthritis epidemiology. Best Pract Clin Rheumatol 2006;20:3-25.
Yun Wang, Xianling Zhao. Mitochondrial biogenesis is impaired in osteoarthritis chondrocytes but reversible via peroxisome proliferator-activated receptor gamma. Arthritis Rheum 2015;67:2141-53.
Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Arthritis Rheum 2010;43:1905â€“15.
Bottiglieri T. S-Adenosyl-L-methionine (SAMe): from the bench to the bedside-molecular basis of a pleiotropic molecule. Am J Clin Nutr 2002;76:1151Sâ€“7S.
Turek S. The Knee. Orthopaedics: principles and their complication. 4th edition. New Delhi: JaypeeBrothers; 1989. p. 1367-71.
Colville-Nash PR, Willoughby DA. COX-1, COX-2, and articular joint disease: a role of chondroprotective agents. Biorheology 2002;39:171-9.
Martel-Pelletier J, Mineau F, Jolicoeur FC, Cloutier JM, Pelletier JP. In vitro effects of diacerein and rhein on interleukin 1 and tumor necrosis factor-alpha system in human osteoarthritic synovium and chondrocytes. J Rheumatol 2001;25:753-62.
Harmand MF, Vilamitjana J, Maloche E. Effects of S-adenosylmethionine on human articular chondrocyte differentiation. Am J Med 1987;83:48-54.
Papakostas GI. S-adenosyl methionine in depression: a comprehensive review of the literature. Curr Psychiatry 2003;5:460-6.
Marcolongo R, Fioravanti A, Adami S, Tozzi E, Mian M, Zampieri A. Efficacy and tolerability of Diacerein in the treatment of osteoarthrosis. Curr Ther Res 1988;43:878-87.
Padova C. S-adenosyl methionine in the treatment of osteoarthritis. Rev Clin Studies. Am J Med 1987;83:60-5.
Jawad. Analgesics and osteoarthritis: Are treatment guidelines reflected in clinical practice? Am J Thera 2005;12:98-103.
Yaron M, Shirazi I, Yaron I. Anti-Interleukin-1 effects of diacerein and rhein in human osteoarthritic synovial tissue and cartilage cultures. Osteoarthritis Cartilage 2009b;7:272-80.
Mendes AF, Caramona MM, de Carvalho AP, Lopes MC. Diacerhein and rhein prevent interleukin-1beta-induced nuclear factor-kappa B activation by inhibiting the degradation of inhibitor kappa B-alpha. Pharmacol Toxicol 2002;91:22e8.
Felisaz N, Boumediene K, Ghayor C, Herrouin JF, Bogdanowicz P, Galera P, et al. Stimulating effect of diacerein on TGF-b1 and b2 expression in articular chondrocytes cultured with and without interleukin-1. Osteoarthritis Cartilage 2004;7:255e64.
Douni E, Sfikakis PP, Haralambous S, Fernandes P, Kollias G. Attenuation of inflammatory polyarthritis in TNF transgenic mice by diacerein: comparative analysis with dexamethasone, methotrexate and anti-TNF protocols. Arthritis Res Ther 2004;6:R65-72.
Zheng WJ, Tang FL, Li J, Zhang FC, Li ZG, Su Y, et al. Efficacy and safety of diacerein in osteoarthritis of the knee: a randomized, multicenter, double-dummy, diclofenac-controlled trial in China. APLAR J Rheumatol 2006;9:64-9.
Dougados M, Nguyen M, Berdah L, Mazieres B, Vignon E, Lequesne M. Evaluation of the structure modifying effects of diacerein in hip osteoarthritis: ECHODIAH, a three-year, placebo-controlled trial. Arthritis Rheum 2001;44:2539-47.
Pelletier JP, Mineau F, Fernandes JC, Duval N, Martel-Pelletier J. Diacerhein and Rhein reduce the interleukin 1b stimulated inducible nitric oxide synthesis level and activity while stimulating cyclooxygenase-2 synthesis in human osteoarthritic chondrocytes. J Rheumatol 1998;25:2417-24.
Nicolas P, Todd M, Padoin C, Petitjean O. Clinical pharmacokinetics of diacerein. Clin Pharmacokinet 1998;35:347-59.
Dougados M, The group for the Respect of Ethics and Excellence in Sciences (GREES) Osteoarthritis Section. Recommendations for the registration of drugs used in the treatment of osteoarthritis. Ann Rheum Dis 1996;55:552-7.