Achieving sustained minimal disease activity with methotrexate in early interleukin 23-driven early psoriatic arthritis
Achieving sustained minimal disease activity with methotrexate in early interleukin 23-driven early psoriatic arthritis
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DOI：
10.1136/rmdopen-2020-001175
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发表时间：
2020-07-01
期刊：
影响因子：
6.2
通讯作者：
Kok, Marc R.
中科院分区：
文献类型：
--
作者：
den Braanker, Hannah;Wervers, Kim;Kok, Marc R.
目标 甲氨蝶呤 (MTX) 目前是治疗银屑病关节炎 (PsA) 的推荐一线疗法，尽管缺乏明确的证据。目前尚无 MTX 在常规护理中的疗效估计，也没有明确的 MTX 反应性临床或实验室变量。本研究描述了在常规护理中新诊断的 PsA 患者对 MTX 单药治疗的反应。其次，我们比较了对 MTX 单药治疗有反应和无反应的患者的临床变量和细胞因子谱。方法我们使用荷兰西南部早期银屑病关节炎队列研究中收集的数据来选择患有少关节炎或多关节炎的 PsA 患者，并进行至少 1 年的随访。我们分析了开始 MTX 单药治疗并在诊断后 1 年后仍使用 MTX 单药治疗的患者 6 个月时的疾病活动情况。使用基于微珠的多重免疫测定在基线以及 3 个月和 6 个月后确定细胞因子谱。 结果 我们确定了 219 名患者，其中 183 名 (84%) 患者在诊断后 6 个月内开始 MTX 单药治疗。 90 名患者在第一年使用 MTX 单药治疗，其中 44 名患者 (24%) 在 6 个月时达到最低疾病活动度 (MDA)，1 年后减少至 33 名患者 (18%)。无反应者在 MTX 治疗前和治疗期间的白细胞介素 (IL) 23 和 IL-10 浓度显着升高。 结论 我们的结果显示，在 MTX 单药治疗 1 年后，只有 18% 的 PsA 患者处于持续性 MDA，无反应者更常患有 IL-23 驱动的疾病。我们的结果表明银屑病关节炎需要更多的靶向治疗和个性化治疗策略。
Objectives Methotrexate (MTX) is currently the recommended first-line therapy for treating psoriatic arthritis (PsA), despite lacking clear evidence. No estimates of efficacy of MTX in usual care and no clear MTX responsive clinical or laboratory variables are currently available. This study describes the response to MTX monotherapy in newly diagnosed patients with PsA in usual care. Second, we compared clinical variables and cytokine profiles in patients responding and not responding to MTX monotherapy.Methods We used data collected in the Dutch southwest Early Psoriatic Arthritis cohoRt study to select patients with PsA with oligoarthritis or polyarthritis, and at least 1 year follow-up. We analysed disease activity at 6 months of patients who started MTX monotherapy and still used MTX monotherapy 1 year after diagnosis. Cytokine profiles were determined at baseline and after 3 and 6 months with a bead-based multi-immunoassay.Results We identified 219 patients of which 183 (84%) patients started MTX monotherapy within 6 months after diagnosis. 90 patients used MTX monotherapy throughout the first year of which 44 patients (24%) reached minimal disease activity(MDA) at 6 months, decreasing to 33 patients (18%) after 1 year. Non-responders had significantly higher concentrations of interleukin (IL) 23 and IL-10 before and during MTX therapy.Conclusions Our results showed that only 18% of patients with PsA are in sustained MDA after 1 year of MTX monotherapy and non-responders more often had IL-23driven disease. Our results indicate the need for more treatto-target and personalised therapy strategies in PsA.