Treatment of rheumatoid arthritis with levamisole

Levamisole has been shown to be an effective, penicillamine-like drug. Its action is slow, it improves extra-articular features of the disease and reduces ESR and rheumatoid factor titre. Comparison with penicillamine has shown the two drugs to be comparable in effectiveness. Experience with different dosage regimes of levamisole suggest that 150 mg weekly is the optimal dose. It is as effective as larger doses and with fewer adverse reactions. Problems with levamisole have included neutropenia and rashes. The latter are sometimes severe and vasculitic. As with penicillamine some of the late complications of levamisole appear to be associated with immune complex deposition.