Auranofin in Rheumatoid Arthritis: Use in Patients with Side-Effects or Lack of Effect to Gold Sodium Thiomalate or Gold Thioglucose and/or D-penicillamine

Auranofin is a gold compound (triethylfosfine-gold) for peroral use which in clinical trials in patients with rheumatoid arthritis (RA) has been found superior to placebo (1-3) and comparable with parenterally injected gold salts (gold sodium thiomalate (GST) (Myocri-sin®) (3-6) or gold thioglucose (GT) (Sanocrysin®) and with orally administered D-penicillamine (D-pen) (7-10). Auranofin seems appropriate as an early alternative remission inducing drug (RID) in patients with active RA, since less severe side-effects have been reported. Although the pathophysiological action of auranofin is thought to be different from that of GST and GT it has been hypothesized that side-effects induced during GST and GT treatment may reappear during later gold therapy using auranofin. It is likewise an open question whether patients with active RA and a history of side-effects to or no effect of D-pen have an increased risk to develop auranofin side-effects. These questions have obvious clinical implications, since auranofin is a relevant and attractive drug for inducing remission in patients with active RA.