A Comparision Between Bucillamine And D-Penicillamine In The Treatmnt Of Rheumatoid Arthritis

Kim, Hyun Ah; Song, Young Wook

Abstract

OBJECTIVE
In order to compare the clinical effect and frequency of side effects between d-penicillamine and bucillamine, a chemical derivative of d-penicillamine, we conducted a randomized, controlled clinical trial.
METHODS
22 and 24 patients were allocated in each treatment arm, after stratification according to functional class, anatomical stage, and concomittant steroid use. We evaluated tender joint count, swollen joint count, tenderness score, duration of morning stiffness, and grip strength every 4 weeks. Westergren ESR, hemoglobin, leucocyte and platelet count were also checked every 4 weeks, and C-reactive protein(CRP)quantitation and rheumatoid factor(RF) titration were checked at baseline and 16 weeks. Study period spanned 16 weeks.
RESULTS
At the end of the trial, both swollen joint count and tenderness score decreased significantly from baseline in both groups, whereas tender joint count decreased siginficantly in bucillamine-treated group only. Grip strength also improved significantly in bucillamine group. Duration of morning stiffness decreased in both groups. When we arbitrarily defined response as more than 30% decrease in both tender and swollen joint count from baseline, 27% of bucillamine group and 33% of d-penicillamine group responded. The response rate did not differ significantly between the 2 groups. ESR and RF decreased in both groups, whereas CRP decreased significantly only in bucillamine group. The frequency of side effects lasting more than 1 day and possibly related to drug was 14% and 37% in bucillamine and d-penicillamine group, respectively. The difference was statistically not significant.
CONCLUSIONS
Bucillamine is as effective as d-penicillamine in the treatment of rheumatoid arthritis. The frequency of side effect tended to be lower.