AuranofinRx

Trade Names: Ridaura

Synonyms: Oral gold

Drug Class: DMARD

Preparations: 3-mg capsule

Dose: Adults, 6 mg p.o. daily as single or divided dose. If no response after 6 months, it can be increased to 9 mg/day (in 3 divided doses). If no response after a further 3 months, discontinue and consider an alternative DMARD.

Indications: Active RA

Mechanism of Action: Unknown; has several immunomodulatory effects, primarily affecting macrophages, including inhibition of phagocytosis

Contraindications: Hypersensitivity to gold; prior blood dyscrasias; severe renal impairment

Precautions: May exacerbate or cause exfoliative dermatitis. Use caution in hepatic or renal impairment.

Monitoring: CBC (WBC count with differential, hemoglobin, and platelet count) and urinalysis before, 1–2 weeks after starting treatment, and then monthly. In patients who have tolerated auranofin well for >12 months, the frequency of monitoring can often be decreased to every 2–3 months.  Check renal and liver function periodically. Discontinue use if significant rash, proteinuria, or decrease in blood counts develops.

Pregnancy Risk: C

Adverse Effects
Common: Diarrhea or loose stools (approx 50%), rash, itching, mouth ulcers, proteinuria, conjunctivitis
Less common: Leukopenia, thrombocytopenia, agranulocytosis, aplastic anemia, hepatotoxicity, peripheral neuropathy, angioedema

Drug Interactions: Toxicity of other DMARDs may be increased if used in combination therapy.

Patient Instructions: Avoid sunlight because photosensitivity may occur. Regular monitoring of urine and blood count is required. Discontinue if rash develops. It may take as long as 3 months for benefits to appear.

Comments: Onset of antirheumatic action is slow, over several months. Auranofin is seldom prescribed but is occasionally used for patients with early and mild disease. The combination of auranofin with MTX did not increase efficacy but did increase side effects.

Clinical Pharmacology: Oral absorption is 25%. Renal excretion is the major route of elimination. The plasma half-life is 26 days.

Cost: $$$$$

BIBLIOGRAPHY

American College of Rheumatology Committee on Rheumatoid Arthritis Guidelines. Guidelines for the management of rheumatoid arthritis: 2002 update. Arthritis Rheum 2002;46:328–346. PMID:11840435