Long term effectiveness of RA-1 as a monotherapy and in combination with disease modifying anti-rheumatic drugs in the treatment of rheumatoid arthritis

Abstract

Background: Data on long term use of Ayurvedic drugs is sparse. They may prove useful if combined with modern medicine in certain clinical situations (integrative medicine). We present the results of a long term observational study of RA-1 (Ayurvedic drug) used in the treatment of rheumatoid arthritis (RA).

Objective: The objective was to study safety of long term use of RA-1 for treatment of rheumatoid arthritis (RA).

Materials and methods: On completion of a 16 week randomized controlled study, 165 consenting volunteer patients were enrolled into a three year open label phase (OLP) study. Patients were symptomatic with persistent active disease and naïve for disease modifying anti-rheumatic drugs (DMARD). 57 patients were on fixed low dose prednisone. Patients were examined every 10-14 weeks in a routine rheumatology practice using standard care norms. They continued RA-1 (Artrex ™, 2 tablets twice daily) throughout the study period and were generally advised to lead a healthy life style. Based on clinical judgment, rheumatologist added DMARD and/or steroids (modified if already in use) to patients with inadequate response; chloroquine and/or methotrexate commonly used. Treatment response was assessed using American College of Rheumatology (ACR) efficacy measures and ACR 20% improvement index standard update statistical software (SAS and SPSS) were used; significant at p < 0.05.

Results: 158, 130 and 122 patients respectively completed evaluations at 1, 2 and 3 year primary end point. The ACR 20 response (range 34-40%) remained stable over three years (p = 0.33). Patients improved optimum for several measures by one year (p < 0.05) and this was sustained. The use of steroids varied from 42 to 49% patients at yearly end points (mean daily dose 5 mg prednisone); correspondingly the use of DMARD varied from 20 to 34% patients. 40% patients on RA-1 did not require DMARD/steroids for control of disease. 77% patients reported adverse events, albeit mild and mostly gut related, and not causing withdrawal. Several study limitations (especially self-selection) were reduced by the high patient retention and consistency in drug use.

Conclusion: RA-1 is safe and effective in the long term management of symptomatic active chronic RA. DMARDs and/or steroids can be used judiciously along with RA-1 to treat difficult disease/flares. Further studies are required to evaluate RA-1 in early RA. This paves way for research and application of integrative therapeutic approach in clinical medicine.

Keywords: Ayurveda; Herbal drug; Integrative medicine; Rheumatoid arthritis; Treatment.

Fig. 1

Mean efficacy measures in patients of rheumatoid arthritis (RA) treated with supervised RA-1 (Ayurvedic drug) and followed for 3 years after an initial randomized placebo controlled phase (16 weeks); after 16 weeks patients with inadequate response also received supervised oral methotrexate and/or hydroxychloroquine and/or oral steroids (prednisolone ≤ 7.5 mg daily); JCPT: Joint Count for pain and tenderness (0–68); JCSW: Joint count for swelling (0–66); HAQ: CRD Version Indian Health Assessment Questionnaire (0–24); PainVAS: Pain Visual Analog scale (0–10 cm); range for measures shown in parentheses; see text for details.