Objectives To determine the state of application and the fate of traditional disease modifying antirheumatic drugs (DMARDs) during the years before the introduction of new DMARDs including biologic agents.
Methods In a historical prospective analysis the fate of DMARD therapies in 593 patients, comprising a total number of 1319 courses of DMARDs over a period of 2378 patient years, were analysed. DMARD dosages, treatment durations, reasons for discontinuation and adverse events reported by either the patients or physicians as well as CRP and ESR were analysed. Drug retention rates were estimated using Kaplan-Meier-analysis.
Results Methotrexate (MTX), chloroquine (CQ), and sulfasalazine (SSZ) emerged as the drugs most commonly applied during the past 15 years,1 whereas gold salts and D-penicillamine (DPA) were used less frequently during the past decade. Three of four therapies had to be terminated for either inefficacy (37%) or adverse events (42%).2 Patients on high dose therapy had significantly longer median retention rates than those on low dose therapy (SSZ: 34 vs. 7 months; MTX: 73 vs. 39 months). Interestingly, rather than inefficacy, toxicity was the main reason for discontinuation of MTX and SSZ at low doses.
The most commonly encountered adverse events leading to discontinuation were nausea, abdominal pain and rashes (the latter mainly with gold salts and DPA).2,3 Median retention rates lasted 36 months).
Conclusion MTX, SSZ and antimalarials became the most commonly used traditional DMARDs for RA. High dose therapy can be continued longer than low dose therapy, and DMARD use is rather limited by toxicity than by inefficacy. Once tolerated, DMARDs can be retained for long periods of time.
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Fries JF, Williams CA, Ramey D, Bloch DA. The relative toxicity of disease-modifying antirheumatic drugs. Arthritis Rheum. 1993;36:297–306
Wolfe F. Adverse drug reactions of DMARDs and DC-ARTs in rheumatoid arthritis. Clin Exp Rheumatol. 1997;15(Suppl 17):S75–81
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