CATEGORY-III SYMPTOM-MODIFYING ANTIRHEUMATIC DRUGS - A COMPARATIVE REVIEW

The antirheumatic drugs used in the treatment of rheumatoid arthritis have recently been reclassified, There are 2 main groups: (a) symptom- modifying antirheumatic drugs, including nonsteroidal anti-inflammator y drugs (category I), corticosteroids (category II) and slower-acting drugs such as gold, methotrexate, sulfasalazine and cytotoxic agents ( category III); and (b) disease-controlling antirheumatic therapy. The category III symptom-modifying drugs are compared, in particular metho trexate with sulfasalazine; gold with penicillamine; cyclophosphamide with azathioprine; cyclosporin; and hydroxychloroquine with chloroquin e. Comparative studies of these drugs include a meta-analysis of short term trials (<1 year), with the end-points being drug efficacy and to xicity. The drugs with the best efficacy : toxicity ratio were hydroxy chloroquine and methotrexate. From these studies, methotrexate is the drug of first choice for mild to severe rheumatoid arthritis. Hydroxyc hloroquine with its low toxicity is the drug of choice for mild rheuma toid arthritis. These data are also supported by survival analysis of drug therapy. If duration of therapy is assumed to be a measure of eff icacy in the long term, then methotrexate is the most effective drug a nd hydroxychloroquine the least toxic.