Adding Gold Therapy Useful When Methotrexate Fails for Rheumatoid Arthritis

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Adding Gold Therapy Useful When Methotrexate Fails for Rheumatoid Arthritis

Arthritis Rheum 2005;52:1360-1370.

http://www.medscape.com/viewarticle/505561?src=mp

NEW YORK (Reuters Health) May 26 - Adding weekly intramuscular gold therapy

can improve the clinical response of rheumatoid arthritis patients who have

a suboptimal response with methotrexate, according to a report in the May

issue of Arthritis & Rheumatism.

Findings from several observation studies have shown that IM gold can

augment the treatment response seen with methotrexate, but until now, this

has not been investigated in a randomized, placebo-controlled trial.

The study, which was conducted by Dr. M. Esdaile, from the Arthritis

Research Centre of Canada in Vancouver, and colleagues, involved 65 patients

with a suboptimal response to methotrexate. The subjects were randomized to

the addition of weekly IM gold or placebo. The main outcome measure was the

percentage of patients who met the American College of Rheumatology 20%

(ACR20) improvement criteria at 48 weeks.

The ACR20 rate in the gold group was 61% compared with a rate of just 30% in

the control group, the investigators found (p = 0.014). Similarly, the

proportion of patients meeting ACR 50% and 70% improvement criteria was also

significantly higher in the gold group.

On cost analysis, the addition of gold therapy was superior to the control

strategy, the researchers note. Moreover, due in part to a lack of efficacy,

the number of patients stopping therapy was significantly higher in the

control group than in the gold group: 14 vs. 9.

These results support previous findings indicating that combination therapy

with gold and methotrexate is useful when the latter agent fails to provide

an optimal response, the authors state.

" Given the high costs of alternative disease-modifying anti-rheumatic drugs,

such as leflunomide and the newer biologic agents, we believe that there

continues to be an important role for gold in combination with methotrexate,

especially when cost is an issue, " Dr. Esdaile's team concludes.