Toxicity of D-penicillamine in rheumatoid arthritis

Weiss, Allen S.; Markenson, Joseph A.; Weiss, Marla S.; Kammerer, William H.

doi:10.1016/0002-9343(78)90186-9

Cited by 68 publications

(8 citation statements)

References 15 publications

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“…The Multicentre Trial Group (7), Tsang et a1 (8), Webley and Coomes (9), and Weiss et a1 (10) did not find an increased evidence of toxicity in their Dpenicillamine-treated patients who had received previous gold therapy. This has been confirmed in both younger (<60 years old) and elderly (>60 years old) patients (11).…”

Section: Discussionmentioning

confidence: 99%

“…It is not surprising that these authors have different opinions in regard to the toxicity rate of patients who received D-penicillamine after gold salt therapy, because there have been no standard criteria by which to judge toxicity in the management of rheumatoid disease. The grading and assessment of adverse effects of gold salts and Dpenicillamine have been merely a collective series of personal observations; there have been no common standard definitions among the different groups (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). In parallel controversy in the literature, researchers have asked whether penicillamine effectively binds to gold and could indeed be responsible for the occurrence or recurrence of adverse effects in patients who * The name given by the International Union of Pure and Applied Chemistry to sodium aurothiomalate, as formulated in the National Formulary, is disodium (thiomalate-S)aurate(I).…”

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confidence: 99%

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

Kean

Lock

Howard-Lock

et al. 1982

Arthritis & Rheumatism

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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),

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

Kean

Lock

Howard-Lock

et al. 1982

Arthritis & Rheumatism

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“…The major toxic effects which have been described with the penicillamine-like toxicity [20] of sulfhydryl-containing compounds, i.e. leukope nia, proteinuria, disorders of taste, and significant skin rash, have not been observed in this study nor in the more than 2,000 hypertensive patients studied worldwide [12,13].…”

Section: Discussionmentioning

confidence: 64%

A Comparison of Enalapril plus Hydrochlorothiazide with Standard Triple Therapy in Renovascular Hypertension

Franklin

Smith

1986

Nephron

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This prospective, double-blind, multicenter study compared enalapril plus hydrochlorothiazide with standard triple therapy (STT; hydrochlorothiazide, timolol, and hydralazine) with regard to safety, tolerability, antihypertensive efficacy, and effect on renal function in 75 patients with documented renovascular hypertension. Both groups showed a significant mean decrease in systolic and diastolic blood pressure during the double-blind study, with the enalapril group showing a mean 12 mm greater decrease in systolic blood pressure as compared to STT ( < 0.05). Effective treatment of diastolic hypertension was noted in 96% of the enalapril group as compared to 82% on STT (p < 0.05). STT failure was seen exclusively in patients with bilateral renal artery stenosis of high grade and frequently in association with impaired renal function. ^CPAH, a measure of effective renal plasma flow, showed a significant increase in the enalapril group, as compared to the STT (p < 0.05). In contrast, there was a bimodal response of C_In (GFR): 80% of patients in the enalapril group showed no significant change while 20% (10 patients) showed a mean decrease of 28% along with a 12% increase in C_PAH (p < 0.01). No acute renal failure or toxic side effects were noted in the enalapril group. Enalapril plus hydrochlorothiazide is very effective in treating renovascular hypertension and is without significant toxic side effects. The self-limited increase in serum creatinine seen in 20% of renovascular hypertensive patients receiving enelapril and hydrochlorothiazide may identify a subset of patients with unilateral or bilateral high grade renal artery stenosis who should be treated with angioplasty or operative intervention.

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“…Proteinuria, which may be heavy enough to result in a nephrotic syndrome, occurs in 7-24% of treated patients [9][10][11] and often resolves when the drug is stopped. The renal lesion is usually a membranous nephropathy with small, subepithelial deposits on the outer aspect of the basement membrane.…”

Section: Discussionmentioning

confidence: 99%

Plasma Exchange in the Successful Treatment of Drug-Induced Renal Disease

Swainson¹,

Thomson²,

Short³

et al. 1982

Nephron

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A 20-year-old girl with rheumatoid arthritis who had been treated with D-penicillamine for 7 months presented with fulminating Goodpasture’s syndrome and a focal necrotising glomerulonephritis. A 35-year-old man who had been taking a low dose of phenytoin for epilepsy presented with nephrotic syndrome and a mesangiocapillary glomerulonephritis. CH₅₀, C3 and C4 were low and a high level of immune complexes was detected. Both patients had severe lesions which were unlikely to recover on immunosuppression alone so were treated with intensive plasma exchange. 2 patients are described with serious drug-induced renal disease who recovered with intensive plasma exchange and immunosuppression.

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Toxicity of D-penicillamine in rheumatoid arthritis

Cited by 68 publications

References 15 publications

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

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

A Comparison of Enalapril plus Hydrochlorothiazide with Standard Triple Therapy in Renovascular Hypertension

Plasma Exchange in the Successful Treatment of Drug-Induced Renal Disease

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