THE EFFECT OF DIACEREIN AND MELOXICAM COMBINATION VERSUS MELOXICAM ALONE ON PHYSICAL FUNCTION IN PATIENTS WITH KNEE OSTEOARTHRITIS
DOI:
https://doi.org/10.22159/ajpcr.2018.v11i10.27427Keywords:
Osteoarthritis, Diacerein, Meloxicam, Western Ontario and McMaster Universities Arthritis Index, Physical functionAbstract
Objective: More than 50% of patients with knee osteoarthritis (OA) had an inadequate pain relief in its management. Combination therapy could be the solution to this problem. The aim of this study was to compare the efficacy of combination therapy of diacerein and meloxicam with meloxicam alone in the patient with knee OA.
Methods: A total of 64 knee OA patients were recruited from Rumah Sakit Umum Daerah Dr. Mohammad Soewandhie Surabaya. They were allocated to combination group and single therapy group using randomized controlled trial design. The Western Ontario and McMaster Universities Arthritis Index (WOMAC) physical function questionnaire were assessed in weeks 0–4th. The difference between pre- and post-treatment score and area under the curve (AUC) of WOMAC score were calculated.
Results: Combination therapy and single therapy had significant clinical effect with the downregulated score of WOMAC physical function after 4th week (p<0.05). However, there were no differences in AUC of WOMAC physical function score between combination and single therapy.
Conclusion: Patient with knee OA could gain beneficial efficacies from combination therapy of diacerein and meloxicam. Studies of longer follow-up time to get the differences in AUC of WOMAC physical function score are needed.
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Zhang W, Nuki G, Moskowitz RW, Abramson S, Altman RD, Arden NK, et al. OARSI recommendations for the management of hip and knee osteoarthritis: Part III: Changes in evidence following systematic cumulative update of research published through january 2009. Osteoarthritis Cartilage 2010;18:476-99.
The Indonesian Rheumatism Association. Diagnosis dan Penatalaksanaan Osteoartritis. Jakarta: The Indonesian Rheumatism Association; 2014.
Petterson SC, Barrance P, Buchanan T, Binder-Macleod S, Snyder Mackler L. Mechanisms underlying quadriceps weakness in knee osteoarthritis. Med Sci Sports Exerc 2008;40:422-7.
Fitzgerald GK, Piva SR, Irrgang JJ, Bouzubar F, Starz TW. Quadriceps activation failure as a moderator of the relationship between quadriceps strength and physical function in individuals with knee osteoarthritis. Arthritis Rheum 2004;51:40-8.
Alldredge BK, Affairs A, Francisco S, Corelli RL, Ernst ME, City I, et al. Koda-Kimble and Young’s Applied Therapeutic: The Clinical Use of Drug. 10th ed. Philadelphia, PA: Lippincot Williams and Wilkins; 2013.
Åastowiecka E, Bugajska J, Najmiec A, Rell-Bakalarska M, Bownik I, Jedryka-Góral A, et al. Occupational work and quality of life in osteoarthritis patients. Rheumatol Int 2006;27:131-9.
Conaghan PG, Peloso PM, Everett SV, Rajagopalan S, Black CM, Mavros P, et al. Inadequate pain relief and large functional loss among patients with knee osteoarthritis: Evidence from a prospective multinational longitudinal study of osteoarthritis real-world therapies. Rheumatology (Oxford) 2015;54:270-7.
Jameson K, Balshaw R, Phillips C, Martin GR, Everett SV, Watson DJ, et al. PMS59 inadequate pain relief in knee osteoarthritis and patient reported outcomes: A survey of osteoarthritis real world therapies (SORT) in the United Kingdom. Int Soc Pharm Outcomes Res 2011;14:A313.
Conaghan PG, Peloso PM, Everett SV, Rajagopalan S, Black CM, Mavros P, et al. Inadequate pain relief and large functional loss among patients with knee osteoarthritis: Evidence from a prospective multinational longitudinal study of osteoarthritis real-world therapies. Rheumatology (Oxford) 2015;54:270-7.
Mercadante S, Casuccio A, Agnello A, Pumo S, Kargar J, Garofalo S, et al. Analgesic effects of nonsteroidal anti-inflammatory drugs in cancer pain due to somatic or visceral mechanisms. J Pain Symptom Manage 1999;17:351-6.
Frakes EP, Risser RC, Ball TD, Hochberg MC, Wohlreich MM. Duloxetine added to oral nonsteroidal anti-inflammatory drugs for treatment of knee pain due to osteoarthritis: Results of a randomized, double-blind, placebo-controlled trial. Curr Med Res Opin 2011;27:2361-72.
Ohtori S, Inoue G, Orita S, Takaso M, Eguchi Y, Ochiai N, et al. Efficacy of combination of meloxicam and pregabalin for pain in knee osteoarthritis. Yonsei Med J 2013;54:1253-8.
Fidelix T, Macedo C, Maxwell L, Fernandes Moça Trevisani V. Diacerein for osteoarthritis. Cochrane Database of Systematic Reviews; 2014.
Medhi B. Diacerein: A new disease modulating agent in osteoarthritis. Int J Pharm Med Res 2007;18:48-52.
Mahajan A, Singh K, Tandon VR, Kumar S, Kumar H. Diacerein: A new symptomatic slow acting drug for osteoarthritis. JK Sci 2006;8:173-5.
Lee AS, Ellman MB, Yan D, Kroin JS, Cole BJ, van Wijnen AJ, et al. A current review of molecular mechanisms regarding osteoarthritis and pain. Gene 2013;527:440-7.
Gayathri C, Vanitha S, William FJ, Nirmala P. Comparative analysis of efficacy and safety of diacerein versus S-Adenosyl methionine in the management of osteoarthritis of knee joint. Int J Curr Pharm Res 2017;9:46-51.
Yocum D, Fleischmann R, Dalgin P, Caldwell J, Hall D, Roszko P, et al. Safety and efficacy of meloxicam in the treatment of osteoarthritis: A 12-week, double-blind, multiple-dose, placebo-controlled trial. The meloxicam osteoarthritis investigators. Arch Intern Med 2000;160:2947-54.
Zeidler H, Kaltwasser JP, Leonard JP, Kohlmann T, Sigmund R, Degner F, et al. Prescription and tolerability of meloxicam in day-to-day practice: Postmarketing observational cohort study of 13,307 patients in Germany. J Clin Rheumatol 2002;8:305-15.
Tacca MD, Colucci R, Fornai M, Blandizzi C. Efficacy and tolerability of meloxicam, a COX-2 preferential nonsteroidal anti-inflammatory drug. Clin Drug Inves 2002;11:1-22.
Bellare N, Harshadargekar, Bhagwat A, Situt V, Pandita N. Effect of a combination of glucosamine and chondroitin sulphate supplementation on the symptomatic relief observed in indian patients with knee osteoarthritis. Int J Pharm Pharm Sci 2013;5:647-50.
Patwardhan S, Bodas K, Gundewar S. Coping with arthritis using safer herbal options. Int J Pharm Pharm Sci 2010;2:1-11.
Gupta N, Datta S. Efficacy and safety of diacerein and diclofenac in knee osteoarthritis in Indian patients-a prospective randomized open label study. J Biomed Sci 2012;1:1-14.
Pelletier JP, Yaron M, Haraoui B, Cohen P, Nahir MA, Choquette D, et al. Efficacy and safety of diacerein in osteoarthritis of the knee: A double-blind, placebo-controlled trial. The diacerein study group. Arthritis Rheum 2000;43:2339-48.
Goei Thè HS, Lund B, Distel MR, Bluhmki E. A double-blind, randomized trial to compare meloxicam 15 mg with diclofenac 100 mg in the treatment of osteoarthritis of the knee. Osteoarthritis Cartilage 1997;5:283-8.
Lee CJ, Lee LH, Wu CL, Lee BR, Chen M-L. Clinical Trials of Drug and Biopharmaceuticals. USA: Taylor and Francis Group; 2006.
Pham B, Cranney A, Boers M, Verhoeven AC, Wells G, Tugwell P, et al. Validity of area-under-the-curve analysis to summarize effect in rheumatoid arthritis clinical trials. J Rheumatol 1999;26:712-6.
Schiff M. A rationale for the use of summary measurements for the assessment of the effects of rheumatoid arthritis therapies. Clin Ther 2003;25:993-1001.
Kongtharvonskul J, Anothaisintawee T, McEvoy M, Attia J, Woratanarat P, Thakkinstian A, et al. Efficacy and safety of glucosamine, diacerein, and NSAIDs in osteoarthritis knee: A systematic review and network meta-analysis. Eur J Med Res 2015;20:24.
Tonelli SM, Rakel BA, Cooper NA, Angstom WL, Sluka KA. Women with knee osteoarthritis have more pain and poorer function than men, but similar physical activity prior to total knee replacement. Biol Sex Differ 2011;2:12.
Elboim-Gabyzon M, Rozen N, Laufer Y. Gender differences in pain perception and functional ability in subjects with knee osteoarthritis. ISRN Orthop 2012;2012:413105.
Makalesi A. Türk fizyoterapi ve rehabilitasyon dergisi bu çalışma, hacettepe üniversitesi fiziksel tıp ve klinik ve radyolojik incelemeler sonucunda bilateral. TJPR 2015;26:59-66.
Santos JP, Andraus RA, Pires-oliveira DA, Fernandes MT, Frâncica MC, Poli-frederico RC, et al. Analysis of functional status of elderly with osteoarthritis. Fisioter Pesq 2015;22:161-8.
Elstaar TE, Salama AA, Esaily HG, Bolty SA. Quality of life in patients with primary knee osteoarthritis. Menoufi Med J 2015;29:111-4.
Kulcu DG, Yanik B, Atalar H, Gulsen G. Associated factors with pain and disability in patients with knee osteoarthritis. Turk J Rheumatol 2010;25:77-81.
Riddle DL, Stratford PW. Original article unilateral vs bilateral symptomatic knee osteoarthritis: Associations between pain intensity and function. Rheumatology 2013;52:2229-37.
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