Comparison of phenytoin with auranofin and chloroquine in rheumatoid arthritis--a double blind study.
OBJECTIVE
To evaluate efficacy of phenytoin in modifying the course of rheumatoid arthritis (RA) by comparing it to gold (auranofin) and chloroquine.


METHODS
A double blind, randomized study of 6 months' duration was conducted at the Nizam Institute of Medical Sciences, Hyderabad, India. One hundred and thirty-two patients with active RA (defined by the 1987 ARA criteria) were entered into the study and randomized into 3 groups: phenytoin, chloroquine, or auranofin.


RESULTS
Full data were evaluable in 100 patients who satisfactorily completed the protocol (phenytoin, 35; auranofin, 30; and chloroquine, 35). Twenty-four patients were noncompliant and did not take medication or return for evaluation; 8 patients had the drug withdrawn because of side effects before study completion. For each of the 3 drugs all clinical and laboratory variables improved when pre and posttreatment values (p < 0.05 to 0.001) were compared. There was a greater reduction in posttreatment mean morning stiffness in the chloroquine group than in the phenytoin and auranofin groups (p < 0.05). Posttreatment grip strength was also greatest in the chloroquine group. On the other hand, there were statistically significant decreases in IgM levels in both the phenytoin and auranofin groups (p < 0.001), but not with chloroquine. Among the 53 patients with a disease history of 3-6 months, global outcome was best with phenytoin (16/17), compared to chloroquine (12/18) and auranofin (12/18) (p < 0.03). However, there was no such difference in the 47 patients in all 3 groups with a disease history longer than 6 months. Eight patients had side effects (phenytoin, auranofin, 2; chloroquine, 1) requiring withdrawal of the drug. However, the incidence of side effects was not significantly different for the 3 drugs.


CONCLUSIONS
Our data indicate that phenytoin is comparable to auranofin and chloroquine in its efficacy in RA and may be considered an alternative disease modifying agent for RA.
Rao
U R
UR
Nizam Institute of Medical Sciences, Panjagutta, Hyderabad, India.
Naidu
M U
MU
Kumar
T R
TR
Shobha
U
U
Askar
M A
MA
Ahmed
N
N
Sarada
P
P
Venubabu
K
K
Shantaram
V
V
Menon
G N
GN
D000328:Adult; D000704:Analysis of Variance; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000188:drug therapy*; D001310:Auranofin / Q000009:adverse effects / Q000627:therapeutic use*; D002738:Chloroquine / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007136:Immunoglobulins / Q000097:blood / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D010672:Phenytoin / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use*; D016896:Treatment Outcome
D018501:Antirheumatic Agents; D007136:Immunoglobulins; D001310:Auranofin; D010672:Phenytoin; D002738:Chloroquine