THE RELATIVE TOXICITY OF DISEASE-MODIFYING ANTIRHEUMATIC DRUGS
THE RELATIVE TOXICITY OF DISEASE-MODIFYING ANTIRHEUMATIC DRUGS
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DOI：
10.1002/art.1780360303
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发表时间：
1993-03-01
影响因子：
--
通讯作者：
BLOCH, DA
中科院分区：
文献类型：
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作者：
FRIES, JF;WILLIAMS, CA;BLOCH, DA
目标。比较常用抗风湿药物(DMARDS)治疗类风湿性关节炎(RA)的毒副作用。根据症状、实验室异常和可归因于DMARD治疗的住院时间计算的毒性指数评分，对2747名RA患者进行了评估，这些患者在7278个病人年中接受了3053个疗程的6个DMARD和1309个疗程的泼尼松治疗。结果根据疾病的严重程度和其他协变量进行了调整。毒性最小的是羟氯喹(平均+/-扫描电子显微镜评分1.38+/-0.15)，其次是肌肉注射金(2.27+/-0.17)和紧密结合的D-青霉胺(3.38+/-0.36)、甲氨蝶呤(3.82+/-0.35)和硫唑嘌呤(3.92+/-0.39)。Auranofin(5.25+/-0.32)毒性最大，但这种毒性是由较高的轻微并发症引起的。因金诺芬或羟氯喹治疗而住院的患者没有记录。泼尼松(3.83+/-0.39)具有类似的毒性，尽管可能并不是所有的泼尼松毒性事件都被捕获。作为参考，甲氨蝶呤和硫唑嘌呤的毒性与毒性最大的非甾体抗炎药(消炎痛3.99、托美汀钠3.96和甲氯芬酯3.86)相似。羟氯喹的毒性低于最常用的非甾体抗炎药。DMARDS之间的毒性有很大差异，而特定DMARD和特定非类固醇抗炎药之间的毒性差异较小。
Objective. To compare the toxicities of commonly employed disease-modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (RA).Methods. Toxicity Index scores, computed from symptoms, laboratory abnormalities, and hospitalizations attributable to DMARD therapy, were assessed in 2,747 patients with RA receiving 3,053 courses of 6 DMARDs and 1,309 courses of prednisone over 7,278 patient-years. Results were adjusted for severity of illness and other covariates.Results. least toxic was hydroxychloroquine (mean +/- SEM score 1.38 +/- 0.15), followed by intramuscular gold (2.27 +/- 0.17) and the closely grouped D-penicillamine (3.38 +/- 0.36), methotrexate (3.82 +/- 0.35), and azathioprine (3.92 +/- 0.39). Auranofin (5.25 +/- 0.32) was most toxic, but this toxicity resulted from a high frequency of minor complications. Hospitalizations because of auranofin or hydroxychloroquine therapy were not noted. Prednisone (3.83 +/- 0.39) was of comparable toxicity, although it is likely that not all events of prednisone toxicity were captured. For reference, the toxicity of methotrexate and azathioprine was similar to that of the most toxic nonsteroidal antiinflammatory drugs (NSAIDs) (indomethacin 3.99, tolmetin sodium 3.96, and meclofenamate 3.86). Hydroxychloroquine showed less toxicity than the most commonly used prescription NSAIDs.Conclusion. There are substantial differences in toxicity among DMARDs and less important differences in toxicity between specific DMARDs and specific NSAIDs.