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.

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.

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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 strategy: 

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).

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