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Intermittent treatment with D-penicillamine is effective in lower doses and with fewer adverse effects in patients
M Hakoda1, A Taniguchi, N Kamatani
1Institute of Rheumatology, Tokyo Women's Medical College, Japan.
Objective:
To determine whether intermittent rather than daily administration of D-penicillamine (D-Pen) would effectively reduce the incidence of adverse effects without significantly diminishing the clinical benefits.
Methods:
We conducted an open prospective trial comparing daily and intermittent schedules. Among 76 Japanese patients with rheumatoid arthritis (RA), 37 underwent daily treatment with D-Pen while 39 were given D-Pen intermittently (every Monday, Wednesday, and Friday).
Results:
The mean D-Pen dose was 166.8 and 99.4 mg/day for daily and intermittent groups, respectively, the difference being highly significant (p < 0.0001, Mann-Whitney's U test). The incidence of adverse effects was significantly lower in the intermittent group. Both schedules significantly reduced the activity of RA, as evaluated by clinical and laboratory variables. No significant differences were observed in the degree of improvement between the 2 schedules.
Conclusion:
Intermittent therapy with D-Pen is an effective treatment for patients with RA and its higher degree of flexibility can lead to maximum efficacy for management of patients with RA.
Insights
Intermittent D-penicillamine (D-Pen) therapy for rheumatoid arthritis (RA) significantly lowers adverse effects compared to daily dosing. This approach maintains clinical benefits, offering a more flexible and effective RA management strategy.
Area of Science:
- Rheumatology
- Pharmacology
- Clinical Medicine
Background:
- Rheumatoid arthritis (RA) is a chronic autoimmune disease requiring long-term management.
- D-penicillamine (D-Pen) is a disease-modifying antirheumatic drug (DMARD) used in RA treatment.
- Daily D-Pen administration is associated with a significant incidence of adverse effects.
Purpose of the Study:
- To evaluate if intermittent D-penicillamine (D-Pen) administration reduces adverse effects in RA patients.
- To assess if intermittent D-Pen maintains clinical efficacy compared to daily dosing.
- To determine an optimal D-Pen dosing schedule for RA management.
Main Methods:
- An open prospective trial compared daily versus intermittent D-Pen schedules in 76 Japanese RA patients.
- Patients were divided into two groups: daily D-Pen (n=37) and intermittent D-Pen (n=39, Monday-Wednesday-Friday).
- Clinical and laboratory variables were used to assess RA activity and treatment response.
Main Results:
- The mean daily D-Pen dose was significantly lower in the intermittent group (99.4 mg/day) versus the daily group (166.8 mg/day).
- The incidence of adverse effects was significantly lower in the intermittent D-Pen group.
- Both daily and intermittent D-Pen significantly reduced RA activity, with no significant difference in the degree of clinical improvement between schedules.
Conclusions:
- Intermittent D-penicillamine (D-Pen) therapy is an effective treatment option for rheumatoid arthritis (RA) patients.
- This dosing schedule offers a higher degree of flexibility, potentially leading to maximum efficacy.
- Intermittent D-Pen represents a viable strategy for improved RA management and patient adherence.