Intervention Review

Auranofin versus placebo in rheumatoid arthritis

  1. Maria E Suarez-Almazor1,*,
  2. Carol Spooner2,
  3. Elaine Belseck3,
  4. Beverley Shea4

Editorial Group: Cochrane Musculoskeletal Group

Published Online: 24 APR 2000

Assessed as up-to-date: 21 FEB 2000

DOI: 10.1002/14651858.CD002048


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.

Author Information

  1. 1

    The University of Texas, M.D. Anderson Cancer Center, General Internal Medicine, Ambulatory Treatment and Emergency Care, Houston, Texas, USA

  2. 2

    1G1.52 Walter Mackenzie Health Centre, Division of Emergency Medicine, Edmonton, Alberta, Canada

  3. 3

    University of Alberta, Department of Pediatrics, Alberta, Canada

  4. 4

    University of Ottawa, Institute of Population Health, Ottawa, Ontario, Canada

*Maria E Suarez-Almazor, General Internal Medicine, Ambulatory Treatment and Emergency Care, The University of Texas, M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 437, Houston, Texas, 77030, USA. msalmazor@mdanderson.org.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 24 APR 2000

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

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.

Objectives

To estimate the short-term efficacy and toxicity of auranofin for the treatment of (RA)

Search methods

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.

Selection criteria

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.

Main results

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).

Authors' conclusions

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

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

Auranofin與安慰劑治療類風濕性關節炎之比較

Auranofin是口服金製劑治療類風濕性關節炎,可能因療效在不同研究有不一致結果,口服金製劑用於治療類風濕性關節炎逐漸減少。

目標

評估口服金製劑治療類風濕性關節炎的短期效益與風險。

搜尋策略

搜尋MEDLINE and EMBASE。並手動搜尋參考文獻之文章。

選擇標準

含口服金製劑及安慰劑用於治療類風濕性關節炎之隨機對照試驗及控制對照試驗

資料收集與分析

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(fixedeffects model)分析。

主要結論

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)。

作者結論

口服金製劑用於治療類風濕性關節炎在臨床及統計上有小的益處。其益處比methotrexate及注射金製劑為中等,其長期對健康及X光影像的影響,目前並不清楚。

翻譯人

本摘要由林口長庚醫院余光輝翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

本文評估口服金製劑治療類風濕性關節炎的短期效益與風險。結果顯示6個月時有小的臨床效益,其整體對健康及X光進展影響,目前並不清楚,但可能是中度影響。口服金製劑可能對早期及輕微疾病患者是合適的。