The British Journal of Rheumatology, Vol 37, 992-1002, Copyright © 1998 by British Society for Rheumatology
JD Jessop, MM O'Sullivan, PA Lewis, LA Williams, JP Camilleri, MJ Plant and EC Coles
OBJECTIVE: To compare the efficacy of hydroxychloroquine, penicillamine,
sodium aurothiomalate and auranofin in the treatment of active rheumatoid
arthritis over a period of 5 yr. METHOD: Five hundred and forty-one
patients with definite or classical rheumatoid arthritis were entered into
an open randomized controlled trial with a flexible dose regimen designed
to reflect clinical practice. Decisions to stop treatment with any one of
the disease-modifying anti-rheumatic drugs (DMARDs) were based on an agreed
trial protocol which defined criteria for adverse reactions and therapeutic
failure. The managing physicians' decisions were confirmed in a separate
monitor clinic. RESULTS: The proportion of patients who remained on their
first DMARD or who were in remission at 5 yr was 53% for penicillamine, 34%
for sodium aurothiomalate, 31%, for auranofin and 30% for
hydroxychloroquine (P < 0.001). In patients who stayed on their first
DMARD, all groups showed a 30-50% improvement in C-reactive protein,
erythrocyte sedimentation rate, Ritchie Index and joint stiffness, and a
deterioration in their Larsen score. There was no evidence of physician
bias to explain the larger proportion of patients remaining on
penicillamine for 5 yr. CONCLUSION: Despite the increased popularity of
sulphasalazine and inmmunosuppressives, the drugs in this study continue to
be used worldwide. The natural history of rheumatoid arthritis requires
long- term follow up to establish drug efficacy. Evidence is needed as to
whether the newer regimens will prove to be more effective and safer in the
longer term than the commonly prescribed DMARDs. The data from this trial
will provide a reference for comparison with future studies.
ORIGINAL PAPERS
A long-term five-year randomized controlled trial of hydroxychloroquine, sodium aurothiomalate, auranofin and penicillamine in the treatment of patients with rheumatoid arthritis
University Hospital of Wales, Cardiff.
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