Comparison of auranofin, methotreaxate, and the combination of both in the treatment of rheumatoid arthritis. A controlled clinical trial

Authors

  • H. James Williams MD,

    Corresponding author
    1. Cooperative Systematic Studies of Rheumatic Diseases Program, University of Utah School of Medicine, Salt Lake City.
    • University of Utah Medical Center, 50 North Medical Drive, Salt Lake City, UT 84132
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  • John R. Ward MD,

    1. Cooperative Systematic Studies of Rheumatic Diseases Program, University of Utah School of Medicine, Salt Lake City.
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  • James C. Reading PhD,

    Department of Family and Preventive Medicine
    1. Cooperative Systematic Studies of Rheumatic Diseases Program, University of Utah School of Medicine, Salt Lake City.
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  • Raye H. Brooks BS,

    1. Cooperative Systematic Studies of Rheumatic Diseases Program, University of Utah School of Medicine, Salt Lake City.
    2. Division of Rheumatology and Immunology, Vanderbilt University, Nashville, Tennessee
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  • Daniel O. Clegg MD,

    1. Cooperative Systematic Studies of Rheumatic Diseases Program, University of Utah School of Medicine, Salt Lake City.
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  • John L. Skosey MD,

    1. Cooperative Systematic Studies of Rheumatic Diseases Program, University of Utah School of Medicine, Salt Lake City.
    2. Section of Rheumatology, University of Illinois, Chicago
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  • Michael H. Weisman MD,

    1. Cooperative Systematic Studies of Rheumatic Diseases Program, University of Utah School of Medicine, Salt Lake City.
    2. Division of Rheumatology, University of California, San Diego
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  • Robert F. Willkens MD,

    1. Cooperative Systematic Studies of Rheumatic Diseases Program, University of Utah School of Medicine, Salt Lake City.
    2. Division of Arthritis, Harborview Medical Center, Seattle
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  • Joyce Z. Singer MD,

    1. Cooperative Systematic Studies of Rheumatic Diseases Program, University of Utah School of Medicine, Salt Lake City.
    2. Department of Medicine, State University of New York, Downstate Medical Center, Brooklyn
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  • Graciela S. Alarcón MD,

    1. Cooperative Systematic Studies of Rheumatic Diseases Program, University of Utah School of Medicine, Salt Lake City.
    2. Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham
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  • Elizabeth H. Field MD,

    1. Cooperative Systematic Studies of Rheumatic Diseases Program, University of Utah School of Medicine, Salt Lake City.
    2. Department of Medicine, University of Iowa College of Medicine, Iowa City
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  • Philip J. Clements MD,

    1. Cooperative Systematic Studies of Rheumatic Diseases Program, University of Utah School of Medicine, Salt Lake City.
    2. Division of Rheumatology, School of Medicine, University of California, Los Angeles
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  • I. Jon Russell MD, PhD,

    1. Cooperative Systematic Studies of Rheumatic Diseases Program, University of Utah School of Medicine, Salt Lake City.
    2. University of Texas Health Science Center, San Antonio
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  • Rodney F. Hochman MD,

    1. Cooperative Systematic Studies of Rheumatic Diseases Program, University of Utah School of Medicine, Salt Lake City.
    2. Section of Rheumatology, Guthrie Clinic, Sayre, Pennsylvania
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  • Dimitrios T. Boumpas MD,

    1. Cooperative Systematic Studies of Rheumatic Diseases Program, University of Utah School of Medicine, Salt Lake City.
    2. National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Maryland
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  • Dwight A. Marble PharmD

    1. Cooperative Systematic Studies of Rheumatic Diseases Program, University of Utah School of Medicine, Salt Lake City.
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Abstract

Objective. To compare the relative safety and efficacy of auranofin (AUR), metbotrexate (MTX), and the combination of both in the treatment of active rheumatoid arthritis (RA).

Methods. Three hundred thirty-five patients with active RA were entered into a 48-week, prospective, controlled, double-blind, multicenter trial and were randomly assigned to 1 of 3 treatment groups.

Results. Two hundred eleven patients completed the trial. No remissions were seen, and there were no statistically significant differences among the treatment groups in the clinical or laboratory variables measured. Patients taking AUR alone had a slower onset of response than did patients taking MTX alone or in combination. Withdrawals because of adverse drug reactions were slightly more common for those taking combination therapy, but the differences were not statistically significant. Withdrawals because of lack of response were more common for single-drug therapy, with the difference between AUR and the combination reaching statistical significance. No unexpected adverse drug effects were identified, and all reactions resolved without sequelae.

Conclusion. Except for fewer withdrawals because of lack of response, combination therapy did not demonstrate any advantage in efficacy over single-drug treatment within the time frame of the study.

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