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Penicillamine for rheumatoid arthritis
M E Suarez-Almazor1, C Spooner, E Belseck
1Health Services Research, Veterans Affairs Medical Center, Mailbox Station 152, 2002 Holcombe Blvd, Houston, Texas 77024, USA. mes@bcm.tmc.edu
The Cochrane Database of Systematic Reviews
|May 5, 2000
Summary
D-penicillamine shows significant short-term benefits for rheumatoid arthritis (RA) patients, improving joint counts and pain. However, higher doses increase adverse reactions and withdrawals, indicating a toxicity concern.
Area of Science:
- Rheumatology
- Clinical Pharmacology
Background:
- Rheumatoid arthritis (RA) is a chronic autoimmune disease.
- Disease-Modifying Anti-Rheumatic Drugs (DMARDs) are used to manage RA.
- D-penicillamine is a DMARD with potential therapeutic benefits.
Purpose of the Study:
- To evaluate the short-term efficacy and safety of D-penicillamine in RA treatment.
- To compare D-penicillamine's effects across different dosage ranges.
Main Methods:
- Systematic review of randomized controlled trials and controlled clinical trials.
- Searched multiple databases (Cochrane, Medline, Embase) up to December 1998.
- Assessed trial quality, extracted outcome data, and performed pooled analysis for efficacy and toxicity.
Main Results:
- D-penicillamine demonstrated statistically significant improvements in joint counts, pain, global assessments, and ESR across low, moderate, and high doses compared to placebo.
- Moderate and high doses of D-penicillamine led to significantly higher withdrawal rates and adverse reactions, including renal and hematological issues.
Conclusions:
- D-penicillamine offers significant short-term clinical benefits for RA disease activity.
- Its efficacy is comparable to other DMARDs, but it carries a notably higher toxicity profile.
- Long-term effects on functional status and radiological progression remain uncertain.