title: Endocrine effects of the podophyllotoxine derivative drug CPH 82 (Reumacon) in patients with rheumatoid arthritis.
abstract: CPH 82 is a non-steroid antirheumatic drug containing two benzylidenated podophyllotoxin glucosides with no affinity for the glucocorticoid receptor. Treatment with CPH 82 as single drug therapy significantly decreased serum and urinary cortisol and cortisol metabolites, serum adrenal androgens and urinary androgen metabolites, plasma ACTH and serum interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-alpha), and increased serum levels of sex hormone-binding globulin (SHBG). Significant positive correlations were found between serum TNF-alpha and plasma ACTH and between serum IL-6 and TNF-alpha on the one hand and serum and urinary cortisol and cortisol metabolites on the other. The initial action of CPH 82 on adrenal steroidogenesis may be a reduction in cytokine levels due to the drugs' antiinflammatory effect. This causes decreased ACTH stimulation, resulting in a reduced adrenocortical steroid secretion. Accumulation of the drug in the adrenal cortex may also affect adrenal steroidogenesis. The elevated SHBG levels may be caused by a weak estrogenic activity of the drug.
authors.affiliation: Department of Obstetrics and Gynecology, Karolinska Institutet, Huddinge University Hospital, Sweden.
authors.forename: K
authors.initials: K
authors.lastname: Carlström
authors.forename: P J
authors.initials: PJ
authors.lastname: Hedin
authors.forename: L
authors.initials: L
authors.lastname: Jönsson
authors.forename: T
authors.initials: T
authors.lastname: Lerndal
authors.forename: J
authors.initials: J
authors.lastname: Lien
authors.forename: T
authors.initials: T
authors.lastname: Weitoft
authors.forename: M
authors.initials: M
authors.lastname: Axelson
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000494:pharmacology* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000097:blood* / Q000188:drug therapy / Q000378:metabolism; D004702:Endocrine Glands / Q000187:drug effects*; D005260:Female; D006027:Glycosides / Q000494:pharmacology* / Q000627:therapeutic use; D006706:Homeostasis / Q000187:drug effects; D006801:Humans; D017705:Lignans / Q000494:pharmacology* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011034:Podophyllotoxin / Q000737:chemistry; D013256:Steroids / Q000097:blood / Q000652:urine; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; C059428:CPH 82; D006027:Glycosides; D017705:Lignans; D013256:Steroids; D014409:Tumor Necrosis Factor-alpha; D000324:Adrenocorticotropic Hormone; D011034:Podophyllotoxin