Auranofin versus placebo in rheumatoid arthritis
Editorial Group: Cochrane Musculoskeletal Group
Published Online: 21 JAN 2009
Assessed as up-to-date: 21 FEB 2000
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Suarez-Almazor ME, Spooner C, Belseck E, Shea B. Auranofin versus placebo in rheumatoid arthritis. Cochrane Database of Systematic Reviews 2000, Issue 2. Art. No.: CD002048. DOI: 10.1002/14651858.CD002048.
- Publication Status: Edited (no change to conclusions)
- Published Online: 21 JAN 2009
Auranofin is an oral gold compound used for the treatment of rheumatoid arthritis (RA). The use of auranofin has declined in the past few years, perhaps due in part to conflicting results from different studies.
To estimate the short-term efficacy and toxicity of auranofin for the treatment of (RA)
An electronic literature search was conducted using MEDLINE and EMBASE, followed by hand searches of the reference lists of the trials retrieved from the electronic search.
All randomized controlled trials (RCTs) and controlled clinical trials (CCTs) comparing auranofin against placebo in patients with RA
Data collection and analysis
The methodological quality of the trials was assessed using Jadad's score. Rheumatoid arthritis outcome measures were extracted from the publications for the 6-month endpoint. The pooled analysis was performed using standardized mean differences (SMDs) for joint counts, pain and global assessments. The weighted mean difference (WMD) was used for ESR. Toxicity was evaluated with pooled odds ratios for withdrawals and adverse reactions. A chi-square test was used to assess heterogeneity among trials. Fixed effects models were used throughout.
A statistically significant benefit was observed for auranofin when compared to placebo for tender joint scores, pain, patient and physician global assessments and ESR. The standardized weighted mean difference between treatment and placebo was -0.39 (95% CI -0.54, -0.25) for tender joint scores, -0.08 (95% CI -0.22, -0.07) for swollen joint scores, and the weighed mean difference was -4.68 (95% CI -6.59, -2.77) for pain scores. The WMD for ESR was -9.85mm (95% CI -16.46, -3.25). Withdrawals from adverse reactions were 1.5 times higher in the auranofin group OR = 1.52 (95% CI 0.94, 2.46) but this result was not statistically significant. Patients receiving placebo were four times more likely to discontinue treatment because of lack of efficacy than patients receiving auranofin OR=0.29 (95% CI: 0.19, 0.43).
Auranofin appears to have a small clinically and statistically significant benefit on the disease activity of patients with RA. The beneficial effects appear to be modest compared to drugs such as methotrexate or parenteral gold. Its effects on long term health status and radiological progression are not clear at this time.
Plain language summary
Auranofin for the treatment of rheumatoid arthritis
The objective of this review was to evaluate the short-term efficacy of auranofin for the treatment of rheumatoid arthritis when compared to placebo. Our results show that auranofin appears to be efficacious in the short-term treatment of patients with RA (6 months), and has a small but clinically and statistically significant benefit on the disease activity of these patients. Its effects on overall health status and radiological progression are not clear at this time, but would appear to be modest. Auranofin may be most appropriate for those patients with early and mild disease who are more likely to respond to less potent (and less toxic) therapies.
搜尋MEDLINE and EMBASE。並手動搜尋參考文獻之文章。
研究品質以Jadad score評估。擷取6個月結果指標數據。並以標準化平均差異(SMD)做關節數，疼痛，及總體評估，以加權平均差異(WMD)評估紅血球沈降速率。毒性評估則以退出治療及副作用之勝算比為指標。本文使用卡方檢定各試驗間異質性，並用固定效應模型(fixedeffects model)分析。
口服金製劑用於治療類風濕性關節炎在關節疼痛數目，疼痛，病患及醫師總體評估及紅血球沈降速率皆比安慰劑有統計上差異。 標準化加權平均差異在疼痛關節數目為 −0.39 (95% CI −0.54, −0.25)，腫脹關節數目為 −0.08 (95% CI −0.22, −0.07)，加權平均差異在疼痛為 −4.6 95% CI −6.59, −2.77)，加權平均差異在紅血球沈降速率為 −9.85mm (95% CI −16.46, −3.25)。口服金製劑因副作用退出比安慰劑高1.5倍，但無統計上差異OR = 1.52 (95% CI 0.94, 2.46)，而安慰劑組因無效果而退出比口服金製劑高4倍OR = 0.29 (95% CI: 0.19, 0.43)。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。