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© 1987 British Society for Rheumatology

research-article

SULPHASALAZINE ALONE OR IN COMBINATION WITH D-PENICILLAMINE IN RHEUMATOID ARTHRITIS

A. J. TAGGART, J. HILL, C. ASTBURY, J. S. DIXON, H. A. BIRD and V. WRIGHT

The General Infirmary at Leeds, and the Clinical Pharmacology Unit, Royal Bath Hospital Harrogate HG1 2PS, UK

Correspondence to: Address correspondence to Dr. A. J. Taggart, Department of Therapeutics and Pharmacology, The Queen's University of Belfast, 97 Lisburn Road, Belfast BT97BL, Northern Ireland

Thirty patients (22 women) with active rheumatoid arthritis participated in an open study of 6 months' treatment with either enteric-coated sulphasalazine (SASP) or SASP plus D-penicillamine (DPA). Patients were assessed at regular intervals using a number of clinical and biochemical tests designed to detect specific antirheumatic activity.

There were significant improvements in clinical and laboratory variables with both regimens consistent with second-line activity. Improvements were greater and more numerous with combination therapy. At the end of the trial period, there were nine ‘responders’ in the SASP/DPA group but only six in the SASP group. Neither efficacy nor toxicity could be related to patient acetylator status.

Nausea and dyspepsia were frequent problems with both treatment regimens but dysgeusia and thrombocytopenia were confined to the SASP/DPA group. Study withdrawals were twice as common with combination therapy.

These results suggest that a combination of SASP and DPA is more potent than SASP alone but at the expense of poorer patient tolerance.

KEY WORDS: Rheumatoid arthritis, Sulphasalazine, D-Penicillamine, Combination therapy


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