Dr. (Richard) Michael Mason. Obituary.
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Biomedical subjects
Publications and source records attributed to C G Barnes.
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Sixty-five patients, 33 receiving azathioprine and 32 receiving penicillamine, took part in a one-year, single-blind external-observer trial designed to compare the efficacy and toxicity of these two drugs in the treatment of rheumatoid arthritis. By six months there was a significantly greater rise in haemoglobin and fall in erythrocyte sedimentation rate among those receiving penicillamine, and by one year this difference remained only in the increase in haemoglobin levels. Fifteen patients, 10 on azathioprine and 5 on penicillamine, had to stop treatment because of side effects; 90 single side effects occurred, 48 in those on penicillamine and 42 in those on azathioprine. After one year both drugs were similar in efficacy and toxicity, but longer-term trials are needed. Both drugs were effective.
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Twenty-two patients with osteoarthrosis of one or both knee joints and 28 patients with osteoarthrosis of one or both hips completed a double-blind trial of 500 mg naproxen daily versus 100 mg indomethacin daily. All patients had been on other active medication up to the start of the trial. Identical trial designs were followed with both classes of patients, namely, a crossover pattern of four weeks on each drug with patients being assessed at -2, 0, 2, 4, 6, and 8 weeks. Assessments made included objective measurement of joint range, stair climbing and walking times, and subjective grading of pain present during normal activity, of which the patient kept a daily record. Patients were also questioned at each clinic visit regarding possible side effects. Study groups were comparable for both drugs. In the majority of subjective and objective parameters, there were significant improvements from baseline on both drugs of statistically comparable magnitude. Significantly fewer side effects were noted during the period on naproxen compared with those on indomethacin. There were no abnormalities discovered in hematologic or biochemical tests performed during the course of the trial.
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The ability of azathioprine to reduce the corticosteroid requirements of patients with severe rheumatoid arthritis was tested under double-blind conditions against placebo. After 12 months a significant mean dose reduction of 36% was achieved without undue side-effects. This form of therapy promises to be an advance in the management of severe rheumatoid arthritis.