Auranofin versus Penicillamine in Rheumatoid Arthritis: One-year Results from a Prospective Clinical Investigation

Abstract

Forty patients with definite or classical active rheumatoid arthritis were stratified by the minimization procedure to auranofin (6 mg/day) or penicillamine (go slow and low regime). This investigation is a prospective planned 3 year patient and 'doctor-open' as well as 'doctor-blind' clinical trial. This article describes the results after 12 months. Both drugs decreased disease activity and improved the functional capacity in a similar way. Two patients in the auranofin group and 5 in the penicillamine group stopped treatment due to major side effects. Four other patients in the auranofin group left treatment: 2 due to death from unrelated cause and 2 according to the Helsinki II Declaration. After one year a further patient in the auranofin group and 2 in the penicillamine group stopped treatment due to lack of clinical effect. Side effects due to auranofin were statistically more frequent distal in the gastrointestinal tract (loose stools/diarrhoea) than with penicillamine. In contrast, penicillamine produced significantly more side effects in the oral cavity (mainly taste disturbances) than auranofin. Other side effects were about equal in the two groups, but 2 cases of severe proteinuria and one with obstructive lung disease were observed in the penicillamine group. Only 3 patients did not complain of any untoward effect during the 12-month period. We conclude that on the basis of this one year investigation it is an open question whether one should select auranofin or penicillamine for the treatment of clinical active rheumatoid arthritis.

Low‐dose methotrexate compared with auranofin in adult rheumatoid arthritis

“…In another study, injectable gold and AUR were found to be equally effective, with injectable gold causing more serious toxicity (19). In double-blind comparative trials, the efficacy and safety of AUR and DP were comparable (20,21).…”

Monotreatment With Conventional Antirheumatic Drugs or Glucocorticoids in Rheumatoid Arthritis

“…For our primary analysis of all 132 studies (represented by 130 publications) we used the most frequently reported outcome, TJC. This included imputed TJC values for studies that did not measure TJC (eMethods 5 in Supplement 1), denominated TJCi.…”

Medication‐Induced Taste Disturbances

“…Frequently used medications associated with drug‐induced taste disturbances, identified primarily from case reports 5–51 , are listed in Table 1. Additional lists of medications implicated in taste disorders can be found elsewhere 3…”

“…Xerostomia management involves moistening mucus membranes and increasing salivary secretion. Sucking on hard candy, selecting an agent with lower anticholingergic properties, discontinuing the offending medication, using artificial saliva, and/or using cholinergic agents (eg, pilocarpine 5 mg orally, 3 times daily) may increase the amount of fluid in the mouth 2,9–93 …”