Diacerein is a plant-derived anti-inflammatory drug used to treat osteoarthritis in some parts of Europe and Asia. It works differently from conventional pain relievers by targeting inflammatory pathways involved in joint disease. Credit: Shutterstock

Diacerein did not relieve knee osteoarthritis symptoms in a major trial, but patients should speak with their doctor before stopping it.

For millions of people living with knee osteoarthritis, medications that can meaningfully ease pain remain frustratingly limited. Now, one drug long valued for its anti-inflammatory properties has failed a major test of its effectiveness.

A national study led by the University of Tasmania’s Menzies Institute for Medical Research found that diacerein did not relieve pain or improve function in people with knee osteoarthritis, even among patients with inflammation inside the joint who were considered especially likely to benefit.

Diacerein comes from plants including rhubarb and aloe vera. It has long been recognized for its anti-inflammatory effects and is widely used for osteoarthritis treatment in parts of Europe and Asia.

A major trial falls short

The DICKENS trial was led by Associate Professor Dawn Aitken, head of the Musculoskeletal Research Group at Menzies. It is the largest global study to examine whether Diacerein can reduce pain in people with knee osteoarthritis who also have inflammation inside the joint (effusion synovitis).

“We designed this large trial to test Diacerein in a group of osteoarthritis patients who we thought would have the best chance at benefiting from the drug and found that it did not improve pain or function or decrease local knee inflammation.

“We were hoping that if the drug was effective, it could be included on the Australian Register of Therapeutic Goods (ARTG) as an approved treatment for osteoarthritis in Australia,” Associate Professor Aitken said. “Unfortunately, it’s back to the drawing board to find more effective drug therapies.”

Few drug options remain

Osteoarthritis is the most common type of arthritis. It affects one in five Australians older than 45 and is a major driver of pain, disability, and joint replacement surgery. Even with its broad impact, few effective medication options are available.

Associate Professor Aitken said the trial’s publication in JAMA Internal Medicine, one of the world’s leading medical journals, underscores the importance and rigor of the research.

“While the findings weren’t what we expected or hoped for, publishing this work in JAMA Internal Medicine reinforces the global importance of high-quality research, and we are proud that Menzies is contributing to the global effort to better understand and treat osteoarthritis.”

Care must stay guided

Associate Professor Aitken said she remains hopeful that other drugs now in development may eventually help people living with chronic pain. She also emphasized that treatment approaches beyond medication are already available.

“Chronic pain has a huge impact on the lives of those who live with it, and the lack of effective drug treatments is frustrating.

“While we currently lack drug treatments for chronic pain, we know that the most effective therapies include education, exercise, weight management, and psychological support.”

Despite these results, anyone taking Diacerein should speak with their treating doctor before stopping the medication.

Reference: “Diacerein for Knee Osteoarthritis: A Randomized Clinical Trial” by Dawn Aitken, Guoqi Cai, Catherine L. Hill, Flavia M. Cicuttini, Anita E. Wluka, Yuanyuan Wang, Helen I. Keen, Michael J. W. Thompson, Chhavi Asthana, Benny E. Antony, Xia Wang, Tania Winzenberg, Barbara de Graaff, Kathy Buttigieg, Petr Otahal and Graeme Jones, 2 March 2026, JAMA Internal Medicine.
DOI: 10.1001/jamainternmed.2025.8237

The Menzies Institute acknowledges the National Health and Medical Research Council of Australia for funding the research and TRB Chemedica International S.A for supplying Diacerein free of charge.

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