How Does Auranofin Compare with Methotrexate and Cyclosporin as a Corticosteroid-Sparing Agent in Severe Asthma?

Despite optimal anti-inflammatory treatment of asthma, including use of high dosage, high potency inhaled corticosteroids, a subset of corticosteroid-dependent patients require substantial amounts of daily systemic corticosteroids for adequate control. Several anti-inflammatory modulating agents (auranofin, methotrexate and cyclosporin) have been evaluated for their corticosteroid-sparing properties under such circumstances. This analysis was gleaned primarily from randomised, double-blind, placebo-controlled trials of these agents. Global assessment of corticosteroid-sparing efficacy of these drugs revealed an advantage of auranofin over both methotrexate and cyclosporin. In addition, the comparative adverse event profiles of these drugs indicated that auranofin exhibited milder, more tolerable adverse effects. Therefore, auranofin presents a better risk : benefit option in initial attempts to wean dependent patients from corticosteroids.