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Ann Rheum Dis. Jun 1993; 52(6): 423–428.
PMCID: PMC1005066

Second line (disease modifying) treatment in rheumatoid arthritis: which drug for which patient?

Abstract

OBJECTIVES--The objectives were to assess (a) the comparative merits of commonly used disease modifying drugs in the treatment of rheumatoid arthritis (RA) and (b) the influence of age, gender, and disease duration on the outcome of treatment. METHODS--Collected analysis (meta-analysis) was performed on results obtained during the first year of treatment in 1140 patients with RA treated with gold, penicillamine, sulphasalazine, or auranofin from a single centre. RESULTS--Gold, penicillamine, and sulphasalazine performed similarly, with about 60% of patients continuing to receive each of these drugs for at least one year. Neither gender nor age had an influence on the response to treatment, but patients with a longer disease duration showed a greater tendency to stop treatment. The median percentage improvement was 33% in visual analogue pain score and 50% in erythrocyte sedimentation rate. CONCLUSIONS--Routine use of these drugs should at least equal these results. Any new drug should either be substantially less toxic or at least as efficacious.

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Selected References

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  • Felson DT, Anderson JJ, Meenan RF. The comparative efficacy and toxicity of second-line drugs in rheumatoid arthritis. Results of two metaanalyses. Arthritis Rheum. 1990 Oct;33(10):1449–1461. [PubMed]
  • Grindulis KA, McConkey B. Outcome of attempts to treat rheumatoid arthritis with gold, penicillamine, sulphasalazine, or dapsone. Ann Rheum Dis. 1984 Jun;43(3):398–401. [PMC free article] [PubMed]
  • Situnayake RD, Grindulis KA, McConkey B. Long-term treatment of rheumatoid arthritis with sulphasalazine, gold, or penicillamine: a comparison using life-table methods. Ann Rheum Dis. 1987 Mar;46(3):177–183. [PMC free article] [PubMed]
  • van der Heijde DM, van Riel PL, van Rijswijk MH, van de Putte LB. Influence of prognostic features on the final outcome in rheumatoid arthritis: a review of the literature. Semin Arthritis Rheum. 1988 May;17(4):284–292. [PubMed]
  • Wolfe F, Hawley DJ, Cathey MA. Termination of slow acting antirheumatic therapy in rheumatoid arthritis: a 14-year prospective evaluation of 1017 consecutive starts. J Rheumatol. 1990 Aug;17(8):994–1002. [PubMed]
  • Pullar T, Hunter JA, Capell HA. Sulphasalazine in rheumatoid arthritis: a double blind comparison of sulphasalazine with placebo and sodium aurothiomalate. Br Med J (Clin Res Ed) 1983 Oct 15;287(6399):1102–1104. [PMC free article] [PubMed]
  • Capell HA, Lewis D, Carey J. A three year follow up of patients allocated to placebo, or oral or injectable gold therapy for rheumatoid arthritis. Ann Rheum Dis. 1986 Sep;45(9):705–711. [PMC free article] [PubMed]
  • Pullar T, Hunter JA, Capell HA. Sulphasalazine in the treatment of rheumatoid arthritis: relationship of dose and serum levels to efficacy. Br J Rheumatol. 1985 Aug;24(3):269–276. [PubMed]
  • Pullar T, Hunter JA, Capell HA. Effect of acetylator phenotype on efficacy and toxicity of sulphasalazine in rheumatoid arthritis. Ann Rheum Dis. 1985 Dec;44(12):831–837. [PMC free article] [PubMed]
  • Porter D, Madhok R, Hunter JA, Capell HA. Prospective trial comparing the use of sulphasalazine and auranofin as second line drugs in patients with rheumatoid arthritis. Ann Rheum Dis. 1992 Apr;51(4):461–464. [PMC free article] [PubMed]
  • Madhok R, Zoma A, Torley HI, Capell HA, Waring R, Hunter JA. The relationship of sulfoxidation status to efficacy and toxicity of penicillamine in the treatment of rheumatoid arthritis. Arthritis Rheum. 1990 Apr;33(4):574–577. [PubMed]
  • Bendix G, Bjelle A. Outcome of parenteral gold therapy in RA patients: a comparison between two periods using life-table analysis. Br J Rheumatol. 1991 Dec;30(6):407–412. [PubMed]
  • Pullar T, Capell HA. A rheumatological dilemma: is it possible to modify the course of rheumatoid arthritis? Can we answer the question? Ann Rheum Dis. 1985 Feb;44(2):134–140. [PMC free article] [PubMed]
  • Sambrook PN, Browne CD, Champion GD, Day RO, Vallance JB, Warwick N. Terminations of treatment with gold sodium thiomalate in rheumatoid arthritis. J Rheumatol. 1982 Nov-Dec;9(6):932–934. [PubMed]
  • Thompson PW, Kirwan JR, Barnes CG. Practical results of treatment with disease-modifying antirheumatoid drugs. Br J Rheumatol. 1985 May;24(2):167–175. [PubMed]
  • Wolfe F, Hawley DJ. Remission in rheumatoid arthritis. J Rheumatol. 1985 Apr;12(2):245–252. [PubMed]
  • Capell HA, Brzeski M. Slow drugs: slow progress? Use of slow acting antirheumatic drugs (SAARDs) in rheumatoid arthritis. Ann Rheum Dis. 1992 Mar;51(3):424–429. [PMC free article] [PubMed]
  • van der Heijde DM, van Riel PL, Nuver-Zwart IH, Gribnau FW, vad de Putte LB. Effects of hydroxychloroquine and sulphasalazine on progression of joint damage in rheumatoid arthritis. Lancet. 1989 May 13;1(8646):1036–1038. [PubMed]
  • Scott DL, Dawes PT, Fowler PD, Grindulis KA, Shadforth M, Bacon PA. Anti-rheumatic drugs and joint damage in rheumatoid arthritis. Q J Med. 1985 Jan;54(213):49–59. [PubMed]
  • Pullar T, Hunter JA, Capell HA. Effect of sulphasalazine on the radiological progression of rheumatoid arthritis. Ann Rheum Dis. 1987 May;46(5):398–402. [PMC free article] [PubMed]
  • Capell HA, Murphy EA, Hunter JA. Rheumatoid arthritis: workload and outcome over 10 years. Q J Med. 1991 Jun;79(290):461–476. [PubMed]
  • Paulus HE, Egger MJ, Ward JR, Williams HJ. Analysis of improvement in individual rheumatoid arthritis patients treated with disease-modifying antirheumatic drugs, based on the findings in patients treated with placebo. The Cooperative Systematic Studies of Rheumatic Diseases Group. Arthritis Rheum. 1990 Apr;33(4):477–484. [PubMed]

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