Time to Treatment as an Important Factor for the Response to Methotrexate in Juvenile Idiopathic Arthritis
Time to Treatment as an Important Factor for the Response to Methotrexate in Juvenile Idiopathic Arthritis
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DOI：
10.1002/art.24087
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发表时间：
2009-01-15
期刊：
影响因子：
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通讯作者：
Guchelaar, H. J.
中科院分区：
文献类型：
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作者：
Albers, H. M.;Wessels, J. A. M.;Guchelaar, H. J.
客观的。甲氨蝶呤 (MTX) 是治疗幼年特发性关节炎 (JIA) 最常用的缓解病情抗风湿药物。目前，无法可靠预测个体对 MTX 的反应。识别影响 MTX 反应的临床和遗传因素可能有助于实现个体患者的最佳治疗。方法。对 128 名接受 MTX 治疗的 JIA 患者进行了回顾性研究。使用多元回归分析比较了 MTX 应答者和无应答者之间与 MTX 作用机制相关的 5 个基因的 6 个单核苷酸多态性的 11 个临床参数和基因型。结果。从诊断到开始 MTX 治疗的时间、医生在基线时的总体评估以及起始剂量与开始后 6 个月时对 MTX 的反应显着相关。根据医生的说法，从诊断到开始使用 MTX 的时间较短且疾病活动度较高的患者，但 MTX 剂量较低的患者显示出反应增强。起始剂量对 MTX 反应的影响似乎主要是由于全身性 JIA 亚型的影响。从诊断到开始 MTX 治疗的时间与医生基线时的总体评估高度相关。因此，无法确定每个自变量的精确效应大小。结论。在 JIA 儿童中，从诊断到开始使用 MTX 的时间似乎是 MTX 反应的一个重要因素。我们的结果表明，尽早开始 MTX 治疗将导致疗效增强。
Objective. Methotrexate (MTX) is the most commonly used disease-modifying antirheumatic drug in juvenile idiopathic arthritis (JIA). Currently, individual response to MTX cannot be reliably predicted. Identification of clinical and genetic factors that influence the response to MTX could be helpful in realizing the optimal treatment for individual patients.Methods. A cohort of 128 JIA patients treated with MTX were studied retrospectively. Eleven clinical parameters and genotypes of 6 single nucleotide polymorphisms in 5 genes related to the mechanism of action of MTX were compared between MTX responders and nonresponders using a multivariate regression analysis.Results. The time from diagnosis to start of MTX treatment, physician's global assessment at baseline, and the starting dose were significantly associated with the response to MTX at 6 months after initiation. Patients with a shorter time from diagnosis to start of MTX and a higher disease activity according to the physician but with a lower MTX dose showed an increased response. The effect of the starting dose on MTX response seemed to be mainly due to the influence of the systemic JIA subtype. The time from diagnosis to start of MTX treatment and physician's global assessment at baseline were highly correlated. Therefore, the precise effect size of each independent variable could not be determined.Conclusion. In children with JIA, the time from diagnosis to start of MTX appears to be an important factor for MTX response. Our results suggest that an earlier start of MTX treatment will lead to an increased response.