European League against Rheumatism study of adverse reactions to D-penicillamine.

An international multicentre study of adverse reactions to D-penicillamine was undertaken on 2879 patients exposed to the drug--1491 of them a prospective sample. The majority of patients were being treated for rheumatoid arthritis. Over a period of 18 months, 319 (21%) of patients in the prospective sample developed adverse reactions necessitating drug withdrawal; two thirds of these occurred during the first 3 months of treatment. The most frequently-occurring adverse reactions involved skin (6%), kidneys (4%), gastro-intestinal tract (4%) and haemopoiesis (3%). Adverse effects, considered to be serious by the reporting physician, included fever and leucopenia during the early weeks of treatment and, after some months of drug exposure, proteinuria, myasthenia gravis, dyspnoea and pemphigus. Two patients died, one of fulminating septicaemia and the other was found at autopsy to have had multiple lung abscesses following unexplained anaemia and hemiparesis.