Toxicity profiles of traditional disease modifying antirheumatic drugs for rheumatoid arthritis

• Published in: Annals of the rheumatic diseases Vol. 62; no. 5; pp. 482 - 486
• Main Authors: Aletaha, D, Kapral, T, Smolen, J S
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and European League Against Rheumatism 01.05.2003; BMJ; BMJ Publishing Group Ltd; BMJ Publishing Group LTD
• Subjects: Adult; adverse effects; AEs; antimalarial drugs; Antimalarials - adverse effects; Antirheumatic agents; Antirheumatic Agents - adverse effects; Arthritis, Rheumatoid - drug therapy; AZA; azathioprine; Biological and medical sciences; Bones, joints and connective tissue. Antiinflammatory agents; Complications and side effects; Concise Report; d-Pen; d-penicillamine; disease modifying antirheumatic drugs; DMARDs; Drug therapy; Drug Therapy, Combination; Drugs; Evaluation; Female; Hospitals; Humans; Laboratories; Male; Medical sciences; methotrexate; Middle Aged; Mortality; MTX; oral gold; parenteral gold; Patients; Pharmacology. Drug treatments; Physiological aspects; Rheumatism; Rheumatoid arthritis; Rheumatology; SSZ; Studies; Substance abuse treatment; sulfasalazine; Toxicity; Austria; Human; Immunopathology; Toxicity; Daily living; Diseases of the osteoarticular system; Autoimmune disease; Inflammatory joint disease; Epidemiology; Incidence; Symptomatology; Chemotherapy; Chronic; Treatment; Rheumatoid arthritis; Secondary effect; Antirheumatic agent
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/ard.62.5.482

Background: The progression of rheumatoid arthritis (RA) can be retarded or halted by disease modifying antirheumatic drugs (DMARDs). Next to inefficacy, toxicity limits their use. Objective: To explore the toxicity profiles of DMARDs in daily life. Patients and methods: Five hundred and ninety three patients with RA charts (>2300 patient years of treatment) were reviewed at two rheumatology outpatient clinics. All recorded data on toxicity and reasons for stopping treatment were collected. Results: Adverse events were common reasons for treatment discontinuation (42% of treatments). In 70% they were subjectively reported at the clinical visit, while substantial laboratory abnormalities were seen relatively rarely (9% of treatments: abnormal liver function tests in 5%; haematological abnormalities in 3%; impaired renal function in 1%). No single case of retinopathy from antimalarial drugs (that is, an incidence of <0.3 events/1000 patient years) was found, although eye examinations by the specialists were abnormal 30 times per 1000 patient years, mostly revealing keratopathy. Most commonly reported symptoms per 1000 patient years were nausea (54 events), abdominal pain (37 events), and rashes (34 events). Adverse events were more likely to occur with increasing number of consecutive DMARD courses. Conclusion: The first DMARD course in a patient seems to be safer than the consecutive ones. In addition, the incidence of adverse events (AEs) seems to be similar for high and low dose treatment. Data are also provided on types and incidence of AEs that are consistent with previous studies in other countries and different settings.