TREATMENT OF GLUCOCORTICOID-RESISTANT OR RELAPSING TAKAYASU ARTERITIS WITH METHOTREXATE
TREATMENT OF GLUCOCORTICOID-RESISTANT OR RELAPSING TAKAYASU ARTERITIS WITH METHOTREXATE
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DOI：
10.1002/art.1780370420
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发表时间：
1994-04-01
影响因子：
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通讯作者：
FAUCI, AS
中科院分区：
文献类型：
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作者：
HOFFMAN, GS;LEAVITT, RY;FAUCI, AS
Objective.目的：探讨甲氨蝶呤（MTX）在单纯糖皮质激素（GC）治疗无效的持续性或复发性大动脉炎（Takayasu arteritis）治疗中的作用。进行了每周一次低剂量MTX + GC治疗的开放标签初步研究。根据临床特征、实验室检查异常、常规血管造影检查结果以及撤销GC和MTX治疗的能力评价结局。18例患者入组研究，2例脱落，16例患者随访1.3-4.8年，平均2.8年。MTX（平均稳定剂量为17.1 mg）和GC每周给药导致16例患者中13例（81%）缓解。然而，7例患者（44%）复发，因为GC逐渐减少或接近停药。再次治疗导致缓解，该组7例患者中有3例成功停止GC治疗。在达到缓解的患者中，8例（50%）持续缓解4-34个月（平均18个月），其中4例患者7-18个月（平均11.3个月）不需要GC或MTX治疗。3例患者尽管接受了治疗，但仍发生了疾病进展。大约一半的Takayasu动脉炎患者患有慢性活动性疾病，单独使用GC治疗不能提供持续缓解，从而无法停止治疗。每周低剂量MTX是诱导缓解和最大限度地减少GC治疗和毒性的有效手段。进一步的长期研究将需要评估缓解的持久性和维持MTX治疗的需要，在这个子集的大动脉炎患者。
Objective. To identify the role of methotrexate (MTX) in the treatment of persistent or recurrent Takayasu arteritis that is refractory to treatment with glucocorticoids (GC) alone.Methods. An open-label pilot study of weekly low-dose MTX + GC treatment was performed. Outcome was evaluated according to clinical characteristics, laboratory abnormalities, findings on routinely performed angiographic studies, and ability to withdraw GC and MTX therapy. Eighteen patients entered the study; 2 dropped out, and 16 were followed up for a mean period of 2.8 years (range 1.3-4.8 years).Results. Weekly administration of MTX (mean stable dose of 17.1 mg) and GC resulted in remissions in 13 of 16 patients (81%). However, 7 patients (44%) had relapses as GC was tapered to or near discontinuation. Retreatment again led to remission, and 3 of 7 patients in this group have successfully stopped GC therapy. Of those patients who achieved remission, 8 (50%) have sustained remissions of 4-34 months (mean 18 months), and 4 of this group have not required GC or MTX therapy for 7-18 months (mean 11.3 months). Three patients experienced disease progression in spite of treatment.Conclusion. About half of all Takayasu arteritis patients have chronic active disease for which GC therapy alone does not provide sustained remissions that allow withdrawal of treatment. Weekly low-dose MTX is an effective means of inducing remission and minimizing GC therapy and toxicity in most of these patients. Further long-term studies will be required to assess the durability of remission and the need for maintenance MTX therapy in this subset of Takayasu arteritis patients.