Experience and recommendations for treatment schedule of levamisole in rheumatoid arthritis

A review is presented of the different treatment regimens of levamisole used in rheumatoid arthritis (RA). A large double-blind EULAR multicentre trial has shown that the beneficial effects obtained with continuous (150 mg per day) and with intermittent (3 days per week, 150 mg) treatment are comparable in RA. Unfortunately with both regimens a high frequency of agranulocytosis was observed. Recent data of another double-blind trial have shown that a treatment schedule of 150 mg one day per week gives equally good results as both previous regimens. Furthermore regular control of white blood cell counts 10 hours after intake of the drug can detect early high risk patients for agranulocytosis. Results of longterm use of levamisole in RA are also presented and the different kinds of responses are discussed. Finally the authors propose a treatment scheme. This consists of one single weekly dose of 150 mg; if no response is obtained after 6 or at most 9 months, a final trial can be performed with two intakes of 150 mg each week.