2ND LINE (DISEASE-MODIFYING) TREATMENT IN RHEUMATOID-ARTHRITIS - WHICH DRUG FOR WHICH PATIENT

Objectives-The objectives were to assess (a) the comparative merits of commonly used disease modifying drugs in the treatment of rheumatoid arthritis (RA) and (b) the influence of age, gender, and disease durat ion on the outcome of treatment. Methods-Collected analysis (meta-anal ysis) was performed on results obtained during the first year of treat ment in 1140 patients with RA treated with gold, penicillamine, sulpha salazine, or auranofin from a single centre. Results-Gold, penicillami ne, and sulphasalazine performed similarly, with about 60% of patients continuing to receive each of these drugs for at least one year. Neit her gender nor age had an influence on the response to treatment, but patients with a longer disease duration showed a greater tendency to s top treatment. The median percentage improvement was 33% in visual ana logue pain score and 50% in erythrocyte sedimentation rate. Conclusion s-Routine use of these drugs should at least equal these results. Any new drug should either be substantially less toxic or at least as effi cacious.