Randomized placebo-controlled trial of 2,3-dimercaptosuccinic acid in therapy of chronic arsenicosis due to drinking arsenic-contaminated subsoil water.
BACKGROUND
Chronic arsenic toxicity producing various clinical manifestations is currently epidemic in West Bengal, India, Bangladesh, and other regions of the world. Animal studies have indicated that 2,3-dimercaptosuccinic acid can be used as an oral chelating agent. A prospective, double-blind, randomized controlled trial was carried out to evaluate the efficacy and safety of 2,3-dimercaptosuccinic acid for chronic arsenicosis due to drinking arsenic-contaminated (> or = 50 micrograms/L) subsoil water in West Bengal.


METHODS
Twenty-one consecutive patients with chronic arsenicosis were individually randomized (random number; assignment made by individual not evaluating patients) into 2 groups: 11 patients (10 male, age 25.5 +/- 8 years) received 2,3-dimercaptosuccinic acid 1400 mg/d (1000 mg/m2) in the first week and 1050 mg/d (750 mg/m2) during the next 2 weeks with a repeat course 3 weeks later. The other 10 patients (all male, age 32.2 +/- 9.7 years) were given placebo capsules for the same schedule. The clinical features were evaluated by an objective scoring system before and after treatment. Routine investigations including liver function tests, arsenic concentrations in urine, hair, and nails, and skin biopsy evaluations were also completed.


RESULTS
Though there was improvement in the clinical score of 2,3-dimercaptosuccinic acid-treated patients, similar improvement was observed in the placebo-treated group. There were no statistical differences in the clinical scores between the 2 groups at the beginning and at the end of treatment. Similarly, no differences were found for the other investigated parameters.


CONCLUSIONS
Under the conditions of this study, 2,3-dimercaptosuccinic acid was not effective in producing any clinical or biochemical benefit or any histopathological improvement of skin lesions in patients with chronic arsenicosis.
Guha Mazumder
D N
DN
Department of Gastroenterology, Institute of Postgraduate Medical Education and Research, Calcutta.
Ghoshal
U C
UC
Saha
J
J
Santra
A
A
De
B K
BK
Chatterjee
A
A
Dutta
S
S
Angle
C R
CR
Centeno
J A
JA
D000293:Adolescent; D000328:Adult; D000931:Antidotes / Q000627:therapeutic use*; D001151:Arsenic / Q000032:analysis / Q000528:radiation effects*; D002908:Chronic Disease; D004311:Double-Blind Method; D006801:Humans; D007194:India; D008111:Liver Function Tests; D008297:Male; D011041:Poisoning / Q000188:drug therapy / Q000473:pathology; D011446:Prospective Studies; D012867:Skin / Q000473:pathology; D004113:Succimer / Q000627:therapeutic use*; D014874:Water Pollutants, Chemical / Q000032:analysis / Q000506:poisoning*
D000931:Antidotes; D014874:Water Pollutants, Chemical; D004113:Succimer; D001151:Arsenic