Hill H F, Hill A G, Day A T, Brown R M, Golding J R, Lyle W H
Ann Rheum Dis. 1979 Oct;38(5):429-33. doi: 10.1136/ard.38.5.429.
There is much individual variation in the response of rheumatoid arthritis (RA) to penicillamine, some patients deriving benefit from very small doses. A dose of 750 mg daily is widely regarded as standard, and, while their RA commonly responds, many patients discontinue treatment because of adverse reactions to penicillamine. A more flexible prescribing policy might be more successful in the long term and was tested in 1 group of 20 patients, another receiving a 'standard' regimen, each beginning treatment at a low dose level. Of those who were given increases of dose only if response was poor 17 completed 1 year of treatment on an average maintenance dose of 308 mg daily, but only 11 of the other group on an average dose 613 mg daily. Proteinuria, which was found only in the latter group accounted for 6 withdrawals, all at doses of 625 mg daily or above. The reduction in rheumatoid activity appeared to be of about the same degree among the members of both groups who completed 12 months of treatment. Penicillamine should be given initially in a low dose and this should be raised only if there is lack of response after at least 4 weeks.
类风湿关节炎（RA）患者对青霉胺的反应存在很大个体差异，有些患者服用非常小的剂量就能获益。每日750毫克的剂量被广泛视为标准剂量，虽然大多数RA患者对此有反应，但许多患者因对青霉胺的不良反应而停止治疗。从长远来看，更灵活的给药策略可能会更成功，为此对一组20名患者进行了测试，另一组接受“标准”治疗方案，两组均从低剂量开始治疗。在那些仅在疗效不佳时才增加剂量的患者中，17名患者以平均每日308毫克的维持剂量完成了1年的治疗，而另一组平均剂量为每日613毫克的患者中只有11名完成了1年治疗。蛋白尿仅在后一组中出现，导致6名患者停药，均是在每日剂量625毫克及以上时出现的。在完成12个月治疗的两组患者中，类风湿活动度的降低程度似乎大致相同。青霉胺应从低剂量开始给药，并且只有在至少4周后无反应时才应增加剂量。
