Auranofin is safe and superior to placebo in elderly-onset rheumatoid arthritis

Abstract

The efficacy, toxicity and possible steroid-sparing properties of auranofin in the treatment of elderly-onset rheumatoid arthritis (EORA) were studied in a 2 yr prospective double-blind placebo-controlled clinical trial. Sixty-five patients with onset of arthritis after the age of 60 yr were randomized to either auranofin 3 mg b.i.d. [n = 31, age 70 (61-84) yr, median (range)] or placebo tablets [n = 34, age 72 (60-81) yr]. Oral prednisolone, starting dose 7.5 or 20 mg daily, was used as a rescue drug in patients with intolerable joint pain and stiffness and with C-reactive protein (CRP) > or = 20 mg/l, and was tapered down according to protocol guidelines. Patients receiving auranofin continued therapy for a longer period of time (55% completers) than those on placebo medication (18% completers). The auranofin group consumed significantly less prednisolone, 2.64 (0-11.85) mg/day [median (range)], compared to 5.0 (0-18.33) mg/day in the placebo group (P = 0.006). No group differences at 2 yr follow-up were found for changes in joint pain (P = 0.49), number of swollen joints (P = 0.61), Health Assessment Questionnaire score (P = 0.18) and radiographic damage score (Larsen-Dale index) of the hands (P = 0.84). Within-group changes in radiographic scores were also insignificant. The drop-out rate due to adverse events was surprisingly higher in the placebo group (41%) than in the auranofin group (10%) and, as expected, higher due to lack of effect (29 and 16%). The results indicate that auranofin is safe, superior to placebo and has steroid-sparing capacity in the treatment of EORA. The favourable radiographic outcome in both groups needs confirmation in future studies.

Aggressive treatment in early rheumatoid arthritis: a randomised controlled trial

“…Other studies on the effectiveness of SAARDs were often of shorter duration, or included fewer patients. Summarising these studies, moderate effectiveness of hydroxychloroquine and auranofin has been reported,5 31while better effectiveness for other SAARDs has been found, without clear differences between these SAARDs 1132-34 As for radiological damage, patients treated with IM gold, methotrexate, or sulfasalazine had a slower progression than those treated with hydroxychloroquine, auranofin, or azathioprine when three different trials were compared 20…”

Gold drug auranofin could reduce neuroinflammation by inhibiting microglia cytotoxic secretions and primed respiratory burst

“…Extensive clinical use of AF has shown that this drug has a relatively safe pharmacological profile in humans including elderly patients (Glennas et al, 1997;Kean et al, 1997;Kim et al, 2010). This, in combination with its anti-inflammatory and cytoprotective activity demonstrated by this study may make AF a good treatment option for inflammatory conditions other than rheumatoid arthritis.…”

Repurposing auranofin to combat uropathogenic Escherichia coli biofilms

“…Auranofin has a well‐defined toxicity profile and an acceptable safety for human use (Glennas et al ).Furthermore, studies have demonstrated that auranofin has antibacterial activity against methicillin‐resistant Staphylococcus aureus (MRSA) (Cassetta et al ; Hokai et al ) and inhibitory activity against Gram‐positive bacteria, enterococci, fungi and parasites (Andrade and Reed ; Roder and Thomson ). As such, auranofin has been studied not only as an anti‐rheumatic agent, but also as an antimicrobial agent.…”

“…We sought to find a substance that could act as an anti-biofilm and antimicrobial agent among substances that are already approved for human use. Auranofin has a well-defined toxicity profile and an acceptable safety for human use (Glennas et al 1997). Furthermore, studies have demonstrated that auranofin has antibacterial activity against methicillin-resistant Staphylococcus aureus (MRSA) (Cassetta et al 2014;Hokai et al 2014) and inhibitory activity against Gram-positive bacteria, enterococci, fungi and parasites (Andrade and Reed 2015;Roder and Thomson 2015).…”