Can we develop simple response criteria for slow acting antirheumatic drugs?

Area of Science:

• Rheumatology and Pharmacology
• Clinical Trial Methodology

Background:

• Conventional assessment of antirheumatic drug response involves multiple, separately analyzed clinical and laboratory measures.
• A unified classification is preferable for clinical practice and therapeutic trials, utilizing sensitive and simple measures.

Purpose of the Study:

• To determine the practicality of a single, unified classification for assessing response to slow-acting antirheumatic drugs (SAARDs).
• To evaluate a novel response index based on sensitive clinical and laboratory measures.

Main Methods:

• Prospective study of two patient cohorts (n=145 penicillamine, n=98 sulphasalazine) followed for 12 months.
• Evaluation of 11 clinical and laboratory measures every 3-6 months.
• Development of a five-point (0-4) response index using erythrocyte sedimentation rate, articular index, morning stiffness, and joint pain reduction.

Main Results:

• Most significant changes in patient response occurred by six months, indicating this as the optimal time for classification.
• The developed response index, based on four key measures, demonstrated similar results for both penicillamine and sulphasalazine.
• The proposed index is simple, appropriate, and suitable for clinical practice and drug studies.

Conclusions:

• A unified response index simplifies the assessment of SAARDs.
• The proposed index, utilizing erythrocyte sedimentation rate, articular index, morning stiffness, and joint pain, is practical and effective.
• Further determination of optimal thresholds for each variable is needed to refine the index.