Comparative safety and efficacy of auranofin and parenteral gold compounds: a review.

The comparative safety and efficacy of the orally active gold compound, auranofin, and parenteral gold compounds, principally gold sodium thiomalate, are reviewed. No difference in efficacy was detected in eight of the 12 published studies which compared auranofin and gold sodium thiomalate. Two studies favoured auranofin and two gold sodium thiomalate. Other parenteral gold compounds appeared more effective than auranofin. Adverse reactions and withdrawal rate from parenteral gold was found to be 2-3 times greater than from auranofin. Withdrawals due to inefficacy were found to be higher for auranofin than for parenteral gold although the incidence of inefficacy in the parenteral gold treated population was lower than that reported in other series. The nature of side effects from the two treatments was noticeably different; lower bowel symptoms with auranofin, and mucocutaneous lesions with parenteral gold compounds. Significant laboratory index changes were uncommon with both treatments, proteinuria being the most usual reason for withdrawal. Again the incidence of proteinuria and other laboratory abnormalities was less in the parenteral gold group than previously reported. Auranofin is possibly as effective and is definitely safer than parenteral gold compounds, and allows for longer periods of treatment.