Oct 1, 1992

Use of short-term efficacy/toxicity tradeoffs to select second-line drugs in rheumatoid arthritis. A metaanalysis of published clinical trials

Arthritis and Rheumatism
D T FelsonR F Meenan

Abstract

Preferred drugs for rheumatoid arthritis (RA) should be those that have maximal efficacy with the least toxicity. We evaluated the efficacy and toxicity tradeoffs for drugs frequently used in the treatment of RA. We updated 2 metaanalyses of published clinical trials, by adding trials published through 1990 and trials of azathioprine (AZA). We tested 3 different definitions of efficacy, each plotted against 3 different toxicity measures, for antimalarial drugs, methotrexate (MTX), auranofin, injectable gold, D-penicillamine, sulfasalazine (SSZ), AZA, and placebo. Efficacy measures included composite efficacy (a combination of joint count, grip strength, and erythrocyte sedimentation rate), tender joint count alone, and a measure based on how many patients dropped out due to inefficacy. Toxicity measures were the proportion dropping out due to toxicity, the same dropouts with side effects weighted for severity using a modification of a published toxicity index, and the proportion with severe toxicities (defined as a score of at least 7 of 10 on the toxicity index). The latter were usually organ toxicities (e.g., cytopenias and renal involvement). All 9 efficacy/toxicity tradeoff plots suggested that MTX and antimalarial drugs ha...Continue Reading

Mentioned in this Paper

Penicillamine
Erythrocyte Sedimentation Rate Measurement
Sulfasalazin medac
Kidney
Azathioprine
Rheumatoid Arthritis
Clinical Trials
Methotrexate
Cytopenia
Methotrexate, (DL)-Isomer

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