Treatment of rheumatoid arthritis with levamisole

Abstract

Levamisole, an anthelminthic agent with immunostimulatory properties, was used in a double-blind, controlled therapeutic trial in rheumatoid arthritis. Patients received either levamisole 100 mg 4 days a week, or placebo, for a period of 4 months. Significant improvement in the treated group, as compared with the control group, was found in the number of tender and swollen joints, grip strength, range of joint motion, sedimentation rate, and C-reactive protein. On double-blind global evaluation by the examining physicians, 9 of 14 patients on levamisole and none of 13 on placebo were considered to have improved. Adverse effects did not differ in frequency between the two groups except for mild alteration in taste, which was more common with levamisole. (2,3). contrasting with the suppressive effects of corticosteroids (4) and cytotoxic agents (5). We have performed a double-blind, placebo-controlled trial, which demonstrates that levamisole produces significant shortterm improvement in patients with rheumatoid arthritis. PATIENTS AND METHODSThirty patients with definite or classic rheumatoid arthritis, as defined by the criteria o f the American Rheumatism Association, entered the study with informed consent and were assigned at random to receive identical tablets containing either levamisole 100 mg, or placebo, on 4 consecutive days per week. None of the patients received gold or corticosteroids within 5 months before the trial. All were considered to have active disease and were receiving salicylates and other nonsteroidal antiinflammatory agents, which were continued in the same doses during the study.Assessments were performed on two occasions, 2 days apart, at the beginning and end of the 16-week study period, and at 4-week intervals during the trial, always by the same physician. The measurements included a determination of the number of tender and swollen joints, the number and size of rheumatoid nodules, grip strength, 50-foot walking time, duration of morning stiffness, Westergren sedimentation rate (ESR), and C-reactive protein (CRP). Routine hematologic studies and chemical profile were performed monthly. The range of joint motion, rheumatoid factor by the latex fixation method and skin testing with streptokinase-streptodornase, PPD, candida, and mumps antigens were recorded at the

Treatment of rheumatoid arthritis with levamisole: long-term results and immune changes.

“…These 2 curves are not significantly different, but the trend in favour of levamisole later in the trial is apparent. Levamisole induced significant changes in all 6 measures by 16 weeks (Runge et al, 1977). One patient failed to show benefit and 8 others were unable to complete the 20-week programme owing to side effects (Table 1).…”

“…Group A mitogen responses before levamisole were significantly lower than those of group B (P < 0 -0025) ( Table 4). The patients in Table 3 Mean change in skin test responsiveness related to degree of clinical improvement 3000group A were younger and had a tendency to shorter disease duration and more active arthritis, that is, increased ESR, longer duration of morning stiffness, and more swollen joints ( (Huskisson et al, 1976;Runge et al, 1977) and…”

“…The same definition was used for the placebo group. The differences in clinical measurements in placebo and levamisole treated patients has been published previously (Runge et al, 1977).…”

Interaction between levamisole and aspirin in man.

“…Levamisole, an antihelminthic and stimulant of cell mediated immunity, has recently been shown to be useful in the treatment of rheumatoid arthritis (Huskisson, Dieppe, Scott, Trapnell, Balme & Willoughby, 1977;Runge, Pinals, Lourie & Tomar, 1977). Since levamisole is likely to be used in rheumatoid arthritis with the concurrent administration of other antirheumatic drugs, especially the nonsteroidal antiinflammatory agents, the possibility of pharmacokinetic drug interaction exists.…”

Alteration of lymphocyte function in nzb/nzw mice

“…Several investigators have reported that in vivo administration of levamisole is associated with objective improvement of rheumatoid arthritis (5)(6)(7). Furthermore, the abnormally reduced lectin responses of peripheral blood mononuclear cells from patients with active rheumatoid arthritis and systemic lupus erythematosus (SLE) are improved by in vivo administration of levamisole (8).…”