Abstract for poster #889 on Wednesday, June 09, 1999 at EULAR '99, Glasgow, Scotland.

REUMACON (CPH 82) IN REFRACTORY INFLAMMATORY ARTHRITIS

Elísabet Gudmundsdottir and Helgi Jónsson, Landspítalinn University Hospital, Iceland.

Introduction

Inflammatory arthritis, particularly rheumatoid arthritis, constitutes a therapeutic problem when it is refractory to most or all available DMARDs and combinations of those. The DMARD Reumacon became available on a named patient basis in Iceland in 1994. This is a retrospective report about the experience of this drug in Iceland.

Patients and Methods

Forty-four patients with active inflammatory arthritis (rheumatoid arthritis n=36) were treated with Reumacon in the period from August 94 to June 1998. All had active disease on initial clinical assessment and were in need of increased therapy. Median age was 57.5 years and disease duration 13 years. Prior therapy included glucocorticoids 36, Methotrexate 42, Hydroxychloroquine 24, Sulphasalazine 23, Penicillamine 13, Gold 18, Azathioprine 20, Cyclosporine A 8. In 26 cases Reumacon treatment was combined with Methotrexate and 30 patients were on low dose gluco- corticoids. Drug survival, adverse effects, reasons for dis- continuation and laboratory abnormalities were recorded. ESR and Hemoglobin levels were noted at start of treatment and at 3, 6 and 12 months.

Results

Drug survival by life-table analysis was 88.5% at 6 months, 78.7% at 12 months, 62.5% at 24 months and 49% at 36 months. There were 19 discontinuations, (inefficacy 8, side effects 7, remission 3, and cardiovascular death 1). Clinically relevant side effects were diarrhoea/nausea 6, abnormal liver functions tests 2, oedema 2, dyspepsia 1, impotence 1 and pseudo-cushing's syndrome 1. Drug survival was not affected by age, disease duration, concomitant drugs, rheumatoid factor positivity or ESR, but there was a there was a tendency toward longer drug survival in rheumatoid arthritis compared with other arthritis (p=0.06) and in men compared with women (p=0.07). ESR decreased significantly from entry to 6 and 12 months and Hemoglobin levels were higher at 3, 6 and 12 months.

Conclusion

Reumacon (CPH 82) is well tolerated in refractory arthritis, both as a sole drug and in combination with other DMARDs. Although efficacy needs to be confirmed in controlled studies, long drug survival and laboratory parameters suggest it is an effective addition to current treatment.