Prior gold therapy does not influence the adverse effects of D‐penicillamine in rheumatoid arthritis

Abstract

One hundred fourteen patients with definite or classic rheumatoid arthritis were followed prospectively between January 1976 and April 1981 to monitor their toxicity pattern to D-penicillamine. The influence of previous sodium aurothiomalate therapy on the toxicity pattern of D-penicillamine is described. There was no significant difference in overall outcome of the patients treated with D-penicillamine with respect to adverse effects, whether they had previous gold toxicity, previous gold therapy but no toxicity, or no previous gold therapy. The time from gold toxicity to the start of Dpenicillamine therapy was greater in those who did not develop D-penicillamine toxicity compared with those who did. This difference just reached statistical significance. Total gold salt received had no effect on eventual outcome of D-penicillamine treatment, and the toxicity pattern of D-penicillamine in those patients who had previous gold therapy was similar to those patients who had never received gold therapy.Because therapy with gold salts has not been effective in all patients with rheumatoid disease (1-3) and gold salts do sometimes induce adverse effects (4),

Controlled trial of hydroxychloroquine and d‐penicillamine singly and in combination in the treatment of rheumatoid arthritis

“…We could find no significant relationship between previous gold therapy or toxicity and toxicity to D-penicillamine; this agrees with a recent report by Kean et a1 (17).…”

“…Toxicity data in the D-penicillamine group also agreed generally with what others have found, i.e., side effects arc common and must be watched for diligently, even over the long term (15)(16)(17). A total of 43% of our patients who continued with D-penicillamine therapy developed side effects, and 20% had to discontinue the use of the drug because of them.…”

Nephrotoxicity of gold salts, D-penicillamine, and allopurinol

“…Dood et al [167] noted that all patients who took D-penicillamine within six months after an adverse reaction to gold developed side effects from D-penicillamine, and suggested an interval exceeding six months between treatment with gold and treatment with D-penicillamine in patients who have developed adverse reactions to gold, as this would apparently reduce the risk of adverse reactions to D-penicillamine. Kean et al [103] analyzed the influence of previous sodium aurothiomalate therapy on the toxicity of pattern of D-penicillamine, but they could not confirm a synergistic effect of D-penicillamine. and sodium aurothiomalate that causes increased adverse reaction in patients with rheumatoid disease [103].…”

“…To predict D-penicillamine side effects, the association between side effects and various factors, such as HLA antigens [70,72,130,132,165,166], autoantibodies [167,168], and previous gold toxicity [103,140,169,170] has been studied. Wooley et al [70] investigated the possible relation between HLA antigens and toxicity of D-penicillamine and sodium aurothiomalate in rheumatoid arthritis patients.…”

“…Especially in rheumatoid arthritis, D-penicillamine has been accepted as an effective second line treatment. In spite of its effectiveness, however, it causes many adverse effects, such as skin rashes [101,102], taste abnormalities [102,103], hepatic dysfunction [104][105][106], gastrointestinal toxicity [101,107], proteinuria [102,108], hematuria [109,110], thrombocytopenia [94,111], aplastic anemia [112], lupus-like syndrome [113,114], Goodpasture's-like pulmonary renal syndrome [115][116][117], vasculitis [118,119], myasthenia gravis [120][121][122][123][124], polymyositis [125,126], and dermatomyositis [127]. One or more of these adverse reactions was seen in about 60% of patients treated with Dpenicillamine [102,[128][129][130][131].…”