Auranofin: first choice for remission-inducing drug (RID) therapy in rheumatoid arthritis?

Numerous studies have demonstrated that auranofin (AF) causes less severe side effects than other disease-modifying antirheumatic drugs (DMARDs) such as injectable gold (IG) and D-penicillamine (DPA). As the efficacy of AF appears comparable to that of IG, AF could be the first choice for early and long-term therapy for rheumatoid arthritis (RA). A total of 444 patients were enrolled in 2 uncontrolled, open, multicenter studies in Germany, Austria, and Switzerland; data were evaluated from 300 patients with RA treated for 12 months and 179 patients treated for 24 months. Patients with disease duration of 1 year or less had greater improvement in grip strength, joint index, morning stiffness, and activity index when compared with patients whose disease duration was more than 2 years. Drug treatment prior to AF included IG in 46, DPA in 36, chloroquine in 57, and antineoplastic agents in 5. Within this group, subpopulations were isolated who were withdrawn from prior DMARD therapy due to lack of efficacy or adverse events, and the results of subsequent AF therapy evaluated. Adverse events observed with previous DMARDs, particularly proteinuria, did not necessarily recur with AF. The data from these 2 studies suggest that auranofin can be initiated early in the course of RA and can be used successfully in patients who have experienced lack of efficacy or adverse events with other DMARDs.