Abstract
Background
To conduct a systematic review and network meta-analysis of RCTs with the aims of comparing relevant clinical outcomes (i.e. VAS, WOMAC total and sub-score score, Lequesne Algofunctional index, joint space width change and adverse events) between diacerein, glucosamine and placebo.
Methods
Medline and Scopus databases were searched from inception to August 29th, 2014, using PubMed and Scopus search engines and included RCTs or quasi-experimental designs comparing clinical outcomes between treatments. Data were extracted from original studies. A network meta-analysis was performed by applying weight regression for continuous outcomes and a mixed-effect Poisson regression for dichotomous outcomes.
Results
Thirty-one of 505 identified studies were eligible. Compared to placebo, glucosamine showed significant improvement with unstandardized mean differences (UMD) in total Western Ontario and McMaster Universities Osteoarthritis index (WOMAC), pain WOMAC, function WOMAC, and Lequesne score of −2.49 (95% confidence interval [CI], −4.14, −0.83), −0.75 (95% CI, −1.18, −0.32), −4.78 (95% CI, −5.96, −3.59) and −1.03 (95% CI, −1.34, −0.72), respectively. Diacerein clinically improves visual analog scores, function WOMAC, and stiffness WOMAC with UMD values of −2.23 (95% CI, −2.82, −1.64), −6.64 (95% CI, −10.50, −2.78) and −0.68 (95% CI, −1.20, −0.16) when compared to placebo.
Conclusions
The network meta-analysis suggests that diacerein and glucosamine are equally efficacious for symptom relief in knee OA, but that the former has more side effects.
