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Study protocol for a randomised controlled trial of diacerein versus placebo to treat knee osteoarthritis with effusion-synovitis (DICKENS)


Cai, G and Jones, G and Cicuttini, FM and Wluka, AE and Wang, Y and Hill, C and Keen, H and Antony, B and Wang, X and de Graaff, B and Thompson, M and Winzenberg, T and Buttigieg, K and Aitken, D, Study protocol for a randomised controlled trial of diacerein versus placebo to treat knee osteoarthritis with effusion-synovitis (DICKENS), Trials, 23, (1) Article 768. ISSN 1745-6215 (2022) [Refereed Article]

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Copyright Statement

2022 The Author(s). Open Access This article is licensed under a Creative Commons Attribution 4.0 International License. Attribution 4.0 International (CC BY 4.0).

DOI: doi:10.1186/s13063-022-06715-w


Background: There is an unmet need for treatments for knee osteoarthritis (OA). Effusion-synovitis is a common inflammatory phenotype of knee OA and predicts knee pain and structural degradation. Anti-inflammatory therapies, such as diacerein, may be effective for this phenotype. While diacerein is recommended for alleviating pain in OA patients, evidence for its effectiveness is inconsistent, possibly because studies have not targeted patients with an inflammatory phenotype. Therefore, we will conduct a multi-centre, randomised, placebo-controlled double-blind trial to determine the effect of diacerein on changes in knee pain and effusion-synovitis over 24 weeks in patients with knee OA and magnetic resonance imaging (MRI)-defined effusion-synovitis.

Methods: We will recruit 260 patients with clinical knee OA, significant knee pain, and MRI-detected effusion-synovitis in Hobart, Melbourne, Adelaide, and Perth, Australia. They will be randomly allocated to receive either diacerein (50mg twice daily) or identical placebo for 24 weeks. MRI of the study knee will be performed at screening and after 24 weeks of intervention. The primary outcome is improvement in knee pain at 24 weeks as assessed by a 100-mm visual analogue scale (VAS). Secondary outcomes include improvement in volumetric (ml) and semi-quantitative (Whole-Organ Magnetic Resonance Imaging Score, 03) measurements of effusion-synovitis using MRI over 24 weeks, and improvement in knee pain (VAS) at 4, 8, 12, 16, and 20 weeks. Intention-to-treat analyses of primary and secondary outcomes will be performed as the primary analyses. Per protocol analyses will be performed as the secondary analyses.

Discussion: This study will provide high-quality evidence to determine whether diacerein improves pain, changes disease trajectory, and slows disease progression in OA patients with effusion-synovitis. If diacerein proves effective, this has the potential to significantly benefit the substantial proportion (up to 60%) of knee OA patients with an inflammatory phenotype.

Item Details

Item Type:Refereed Article
Research Division:Biomedical and Clinical Sciences
Research Group:Clinical sciences
Research Field:Rheumatology and arthritis
Objective Division:Health
Objective Group:Clinical health
Objective Field:Efficacy of medications
UTAS Author:Cai, G (Dr Guoqi Cai)
UTAS Author:Jones, G (Professor Graeme Jones)
UTAS Author:Antony, B (Dr Benny Eathakkattu Antony)
UTAS Author:de Graaff, B (Dr Barbara de Graaff)
UTAS Author:Thompson, M (Dr Michael Thompson)
UTAS Author:Winzenberg, T (Professor Tania Winzenberg)
UTAS Author:Buttigieg, K (Ms Kathy Buttigieg)
UTAS Author:Aitken, D (Associate Professor Dawn Aitken)
ID Code:154075
Year Published:2022
Web of Science® Times Cited:1
Deposited By:Menzies Institute for Medical Research
Deposited On:2022-10-27
Last Modified:2022-11-01
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