Auranofin: dose-related risk to benefit

Two separate, double-blind studies examined the most appropriate starting dose of auranofin, an orally administered gold compound, for the management of rheumatoid arthritis. One study indicated that neither of the two tested doses, 1 or 9 mg auranofin daily, was ideal; the 1 mg dose was insufficient therapeutically, whereas the 9 mg dose was associated with frequent lower gastrointestinal side effects. In the other study, which compared 2 and 6 mg auranofin daily, both doses resulted in similar clinical improvement and untoward effects, although the higher dose had greater efficacy sooner. Thus, it appears that 6 mg auranofin daily is the most appropriate starting dose.