Disease modifying antirheumatic drugs in early rheumatoid arthritis: a longterm observational study.

Abstract

OBJECTIVE:

To investigate the effectiveness, toxicity, and drug survival in an observational longterm study of patients with early rheumatoid arthritis (RA).

METHODS:

Four hundred twenty-eight patients with early RA were investigated between January 1987 and December 1995. All patients had a disease duration of less than one year and had not been previously treated with any disease modifying antirheumatic drug (DMARD). The following drugs were introduced at the doses specified: hydroxychloroquine (HCQ) (200-400 mg/day), D-penicillamine (D-Pen) (500 mg/day), sulfasalazine (SSZ) (2-3 g/day), auranofin (6 mg/day), intramuscular gold (IM gold, 50 mg/week), methotrexate (MTX) (0.15 mg/kg/week, per os), cyclosporin A (CSA) (3 mg/kg/day), azathioprine (AZA) (2-3 mg/kg/day), cyclophosphamide (CYC) (1-2 mg/kg/day).

RESULTS:

Three hundred eighty-three patients were treated with one DMARD for at least 6 months. Sixty-five percent of patients were seropositive. The disease duration was 9.2 (3.1) months and the followup period of 12.7 (4.8) years, ranging from 7 months to 13 years. The drugs of first choice were: D-Pen (32%), HCQ (30%), MTX (21%), CSA (8%), and IM gold (7%). After the 2nd, 3rd, and 4th prescriptions, MTX was the most popular drug (27%), while D-Pen and HCQ were prescribed less frequently. The longest drug survival was seen in MTX treated patients, followed by CSA, without significant differences between them. D-Pen, HCQ, and IM gold had the largest dropout rate. The main causes for drug discontinuation were drug inefficacy (HCQ), followed by adverse drug reactions (D-Pen).

CONCLUSION:

It appears that MTX has the longest survival time, with CSA following in second place. The main reasons for discontinuation of treatment were drug inefficacy, followed by adverse drug reactions.

• Authors: Nikolaos G Papadopoulos, Yannis Alamanos, Ioannis A Papadopoulos, Niki Tsifetaki, Paraskevi V Voulgari, Alexandros A Drosos
• Journal: The Journal of rheumatology (J Rheumatol) Vol. 29 Issue 2 Pg. 261-6 (Feb 2002) ISSN: 0315-162X [Print] Canada
• PMID: 11838843 (Publication Type: Journal Article)

Chemical References

• Antirheumatic Agents

Topics

• Antirheumatic Agents (adverse effects, therapeutic use)
• Arthritis, Rheumatoid (drug therapy)
• Female
• Humans
• Male
• Patient Dropouts
• Prospective Studies
• Time
• Treatment Outcome