Evolution of osteoarthritis therapy: synergy of combined use of diacerein and chondroitin sulfate

Osteoarthritis (OA) is one of the most common joint disorders. A promising and rational treatment combination is diacerein with chondroitin sulfate (CS). Their mechanisms of action suggest a potential synergistic effect on various pathogenetic pathways of OA. Objective : to evaluate the safety and efficacy of a combined preparation of diacerein and CS (Diaflex Chondro) in patients with knee OA. Material and methods . The study included 180 patients with knee OA, randomized into three equal groups. Group 1 received a combination of diacerein and CS, Group 2 received diacerein monotherapy, and Group 3 received CS monotherapy. Treatment efficacy was assessed using changes in pain intensity on the Visual Analogue Scale (VAS), WOMAC scores (Pain, Stiffness, Function subscales), and the number of ibuprofen doses taken during the 16-week treatment period. The daily dosage of the combination therapy was 100 mg diacerein + 800 mg CS, compared with 1000 mg CS or 100 mg diacerein in monotherapy. Adverse events (AEs) were recorded to assess safety. Results and discussion . The combination therapy (Diaflex Chondro) demonstrated statistically significant superiority over both monotherapy groups in reducing pain intensity (VAS and WOMAC) throughout the 16-week study. At week 4, the VAS pain reduction in Group 1 was 11.07±9.80 mm and reached 33.78±14.17 mm by week 16. In Group 2, the reduction was 9.48±13.15 mm at week 4 and 27.12±14.77 mm at week 16. In Group 3, these values were 8.05±11.31 mm and 21.87±14.57 mm, respectively. WOMAC pain scores also improved: Group 1 showed a reduction of 12.72 points at week 8 and 21.8 points at week 16; Group 2 – 9.13 and 18.35 points; Group 3 – 8.6 and 16.38 points, respectively. The need for additional ibuprofen use was significantly lower in the combination group compared to CS monotherapy (p=0.004). The average number of ibuprofen doses over 16 weeks was 13.58 ± 13.96 (combination), 19.45±15.19 (diacerein), and 27.03±22.56 (CS). Twelve AEs were reported across the three groups, all mild and related to gastrointestinal disturbances. Conclusion . In patients with stage II–III knee OA, the combination of diacerein and CS (Diaflex Chondro) proved more effective than either agent used alone.