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

H A Capell, D R Porter, R Madhok, J A Hunter

Centre for Rheumatic Diseases, Glasgow Royal Infirmary, United Kingdom.

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.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Tutuncu, Z, Reed, G, Kremer, J, Kavanaugh, A (2006). Do patients with older-onset rheumatoid arthritis receive less aggressive treatment?. Ann Rheum Dis 65: 1226-1229 [Abstract] [Full Text]  
• Scott, D L, Smolen, J S, Kalden, J R, van de Putte, L B A, Larsen, A, Kvien, T K, Schattenkirchner, M, Nash, P, Oed, C, Loew-Friedrich, I (2001). Treatment of active rheumatoid arthritis with leflunomide: two year follow up of a double blind, placebo controlled trial versus sulfasalazine. Ann Rheum Dis 60: 913-923 [Abstract] [Full Text]  
• Hamilton, J, McInnes, I B, Thomson, E A, Porter, D, Hunter, J A, Madhok, R, Capell, H A (2001). Comparative study of intramuscular gold and methotrexate in a rheumatoid arthritis population from a socially deprived area. Ann Rheum Dis 60: 566-572 [Abstract] [Full Text]  
• (1998). Modifying disease in rheumatoid arthritis. DTB 36: 3-6 [Abstract] [Full Text]