| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Letters and Responses |
Second, we do not understand why the authors state that the "conclusions from these reviews on the effect of diacerein on hip [osteoarthritis] OA were based on 7 primary studies."1(p1721) Of the 7 studies reviewed by Fidelix et al,4 3 were conducted only with patients with knee OA, 2 were conducted with patients with knee and hip OA, and 2 were conducted only with patients with hip OA. In our review, we included 2 clinical studies conducted only with patients with hip OA and 8 studies conducted with patients with hip and knee OA.2
In addition, the section on diacerein in Table 1 relating to the review by Fidelix et al appears to indicate that there were 6 placebo-controlled studies and 1 study versus nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with hip OA. It should be stated that these data refer to 2 clinical studies that investigated only patients with hip OA: one of them was a placebo-controlled, structure-modifying study of 3 years' duration that included 507 patients,5 whereas the other was a double-blind, placebo- and naproxen-controlled study in 288 patients with hip OA.6
Furthermore, it remains unclear why Moe et al conclude that there is "low-quality evidence" that treatment with diacerein reduces radiographic OA progression given that the placebo-controlled, structure-modifying study5 received a Jadad score7 of 5 in the review by Fidelix et al4 as well in ours,2 indicating that both groups of authors thought it was a high-quality study. Because only 1 structure-modifying study in patients with hip OA has been performed with diacerein and because the review by Fidelix et al4 gave this study a Jadad score of 5, it appears evident that there is at least "moderate-quality evidence" that treatment with diacerein reduces radiographic OA progression according to the Table 2—Grading Quality of Evidence—in the article by Moe et al.1 Incidentally, in this structure-modifying study, the incidence of total hip replacement was a secondary efficacy parameter. The study was not sized to show a significant difference between groups for the incidence of total hip replacement.5
Last but not least, we do not understand why Moe et al, even citing the review by Fidelix et al, state that there is "moderate-quality evidence" that diacerein "has no effect on pain, impairment, or incidence of total hip replacement."1(p1721) Indeed, Fidelix et al4 concluded that there is "gold"-level evidence that diacerein has a small, consistent benefit in pain improvement. In our meta-analysis, which was more extensive than the one by Fidelix et al, we summarized that diacerein can be considered useful in the treatment of knee or hip OA, because we had found evidence that diacerein was superior to placebo with respect to pain and function and equally effective compared with NSAIDs during the active treatment period.2 With respect to the follow-up period, diacerein was found to be significantly superior compared with NSAIDs concerning pain and function, indicating a carryover effect of the drug once treatment was stopped.2 This has been confirmed by a recently published clinical study targeting particularly this carryover effect.8
BF Leeb, MD, is Director, First and Second Department of Medicine, Center for Rheumatology, Lower Austria, State Hospital Stockerau, Karl Landsteiner-Institute for Clinical Rheumatology, A-2000 Stockerau, Landstrasse 18, Austria
B Rintelen, MD, practices in the First and Second Department of Medicine, Center for Rheumatology, Lower Austria, State Hospital Stockerau
burkhard.leeb{at}stockerau.lknoe.at
 | Footnotes |
|---|
References
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
