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Comparison of Tacrolimus and Mizoribine in a Randomized, Double-blind Controlled Study in Patients with Rheumatoid Arthritis
SHINICHI KAWAI, HIROSHI HASHIMOTO, HIROBUMI KONDO, TAKASHI MURAYAMA, TAKAHIRO KIUCHI, and TORU ABE ABSTRACT. Objective. To compare the efficacy and safety of tacrolimus and mizoribine in patients with rheumatoid arthritis (RA). Methods. Adult patients with RA with an insufficient response to at least one disease modifying antirheumatic drug (DMARD) were randomized to receive 28 weeks of double-blind treatment with tacrolimus 3 mg once daily or mizoribine 50 mg three times daily. The primary efficacy endpoint was the American College of Rheumatology 20% (ACR20) response. Safety was evaluated by adverse events. Results. A total of 204 patients were enrolled for study (103 in the tacrolimus group, 101 in the mizoribine group). Significantly more patients receiving tacrolimus achieved an ACR20 response compared with mizoribine (48.5 vs 10.0%, respectively; p = 0.001). Tacrolimus was also superior to mizoribine in ACR50 and ACR70 response rate, tender and painful joint counts, swollen joint counts and patient and physician assessments of pain, disease activity, and patient's physical function assessment based on the Modified Health Assessment Questionnaire (p < 0.001). Adverse events were more frequent in the tacrolimus group than the mizoribine group (65.0 vs 59.4%); however, there were no statistically significant differences between treatment groups. Conclusion. Tacrolimus improves RA symptoms to a significantly greater extent than mizoribine in patients with RA inadequately controlled with at least one prior DMARD. Tacrolimus has the potential to be a useful and highly effective treatment for RA. (First Release Sept 1 2006; J Rheumatol 2006;33:2153–61) Key Indexing Terms:
TACROLIMUS From the Division of Rheumatology, Department of Internal Medicine, Toho University School of Medicine, Tokyo; Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine, Tokyo; Division of Rheumatology, Department of Internal Medicine, Kitasato University School of Medicine, Sagamihara; Center of Rheumatology and Collagen Diseases, Kanazawa Rehabilitation Hospital, Kanazawa; University Hospital Medical Information Network Center, The University of Tokyo Hospital, Tokyo; and the Second Department of Internal Medicine, Saitama Medical Center, Saitama Medical School, Kawagoe, Japan. Supported by Astellas Pharma Inc., Tokyo, Japan (formerly Fujisawa Pharmaceutical Co., Ltd., Osaka, Japan). Drs. Kawai, Hashimoto, Kondo, Murayama, Kiuchi, and Abe have served as consultants to and/or received honoraria from Astellas Pharma Inc., the manufacturer of tacrolimus. S. Kawai, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Toho University School of Medicine; H. Hashimoto, MD, PhD, Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine; H. Kondo, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Kitasato University School of Medicine; T. Murayama, MD, PhD, Center of Rheumatology and Collagen Diseases, Kanazawa Rehabilitation Hospital; T. Kiuchi, MD, PhD, University Hospital Medical Information Network Center, The University of Tokyo Hospital; T. Abe, MD, PhD, Second Department of Internal Medicine, Saitama Medical Center, Saitama Medical School. Address reprint requests to Prof. S. Kawai, Division of Rheumatology, Department of Internal Medicine, Toho University School of Medicine, 6-11-1 Omori-Nishi, Ota-ku Tokyo 143-8541, Japan. E-mail: skawai@med.toho-u.ac.jp Accepted for publication May 10, 2006.
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