Related Experiment Videos
Penicillamine for treating 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, USA, 77024. mes@bcm.tmc.edu
The Cochrane Database of Systematic Reviews
|October 18, 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, suggesting a higher toxicity profile compared to other disease-modifying anti-rheumatic drugs (DMARDs).
Area of Science:
- Rheumatology
- Clinical Pharmacology
- Evidence-Based Medicine
Background:
- Rheumatoid arthritis (RA) is a chronic autoimmune disease causing joint inflammation and damage.
- Disease-modifying anti-rheumatic drugs (DMARDs) are crucial for managing RA, with D-penicillamine being one such agent.
- Assessing the short-term efficacy and safety of D-penicillamine is vital for clinical decision-making.
Purpose of the Study:
- To systematically evaluate the short-term therapeutic effects of D-penicillamine in patients diagnosed with rheumatoid arthritis.
- To compare the efficacy of D-penicillamine across different dosage ranges against a placebo control.
- To assess the safety profile, including adverse reactions and treatment withdrawals, associated with D-penicillamine use.
Main Methods:
- A comprehensive literature search was conducted across major databases (Cochrane, Medline, Embase) and reference lists up to August 2000.
- Included were randomized controlled trials and controlled clinical trials comparing D-penicillamine with placebo in RA patients.
- Data on efficacy outcomes (joint counts, pain, ESR, global assessments) and toxicity were extracted and analyzed using meta-analysis techniques, stratified by D-penicillamine dosage.
Main Results:
- Six trials involving 425 patients on D-penicillamine and 258 on placebo demonstrated statistically significant benefits for D-penicillamine across all dose ranges.
- Improvements were noted in tender joint counts, pain, physician's global assessments, and erythrocyte sedimentation rate (ESR).
- Moderate and high doses of D-penicillamine led to significantly higher withdrawal rates and adverse reactions, including renal and hematological issues.
Conclusions:
- D-penicillamine exhibits significant short-term clinical benefits in managing rheumatoid arthritis disease activity.
- While effective, its efficacy is comparable to other DMARDs, but it is associated with considerably higher toxicity.
- The long-term impact of D-penicillamine on functional status and radiological progression remains unclear based on this review.