An Overview of the Current Status of Levamisole in the Treatment of Rheumatic Diseases

Summary

Levamisole has been shown to have a penicillamine-like action in rheumatoid arthritis. Like penicillamine, it acts slowly, reaching a peak effect after 4 to 6 months of treatment. It can improve extra-articular features of the disease and reduces ESR and rheumatoid factor. The optimal dosage is 150mg in a single weekly dose. The most common side effect is a reaction occurring after each dose, of variable severity and characterised by symptoms including malaise, nausea and fever. Neutropenia occasionally accompanies this reaction and reaches its peak 12 hours after a single dose. A blood count carried out at this time is therefore a useful precaution. An advantage of the single weekly dose is that treatment can be stopped before the next dose if the blood count necessitates this. Levamisole in a dose of 150mg on 3 or 7 days per week is probably slightly more effective, but much more dangerous. 2 serious side effects, neutropenia and vasculitis, should discourage the use of these regimens. Despite its problems, levamisole is a useful alternative to other penicillamine-like drugs in the treatment of rheumatoid arthritis. Promising results have been reported in systemic lupus erythematosus, and there is some evidence that levamisole may be of use in anky losing spondylitis and Reiter’s disease, but there is scant evidence that it is effective in any other rheumatic disease.