Diacerein in the complex therapy for comorbid patients: current indications and trends for future case studies

Modern rheumatology and therapeutics are well acquainted with diacerein, a drug that was once regarded as innovative and insufficiently studied, but which now represents an established pharmacological agent with proven efficacy as reflected in clinical guidelines for the management of osteoarthritis. Diacerein is classified as a symptomatic slow-acting drug in osteoarthritis (SYSADOA, also referred to as a disease-modifying osteoarthritis drug, DMOAD) exhibiting anti-inflammatory, anti-osteoarthritic, and chondromodulating properties. Its maximal therapeutic efficacy is typically observed after 30–45 days of administration and persists for several months following cessation of therapy. In the present article, the authors elucidate the pharmacokinetic and pharmacodynamic characteristics of diacerein, highlighting the inhibition of pro-inflammatory cytokines as its principal pharmacological action. The discussion also encompasses the underlying mechanisms and mitigation tactics for diacerein-associated adverse events. Moreover, the authors critically evaluate experimental and clinical data on diacerein, considering its potential therapeutic benefits in the context of internal medicine and comorbidities, and underscore rational drug combinations involving diacerein. Keywords: osteoarthritis, comorbidity, SYSADOA, interleukin-1, inflammation, diacerein. For citation: Skotnikov A.S., Knyazeva S.A., Bektemirova L.G. Diacerein in the complex therapy for comorbid patients: current indications and trends for future case studies. RMJ. 2025;6:39–44. DOI: 10.32364/2225-2282-2025-6-8