EFFECTIVENESS AND TOLERABILITY OF METHOTREXATE IN PULMONARY SARCOIDOSIS: A SINGLE CENTER REAL-WORLD STUDY
EFFECTIVENESS AND TOLERABILITY OF METHOTREXATE IN PULMONARY SARCOIDOSIS: A SINGLE CENTER REAL-WORLD STUDY
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甲氨蝶呤治疗肺结节病的有效性和耐受性：单中心真实世界研究
DOI：
10.36141/svdld.v36i3.8449
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发表时间：
2019-01-01
影响因子：
1.6
通讯作者：
Xu, Zuojun
中科院分区：
文献类型：
--
作者：
Fang, Chuling;Zhang, Qian;Xu, Zuojun
背景资料：肺结节病患者尽管使用糖皮质激素治疗但病情进展或不能耐受糖皮质激素，需要二线药物。甲氨蝶呤（MTX）是临床上应用最广泛的药物。关于其在不同剂量下的安全性和有效性的数据仍然有限，特别是对于那些没有叶酸补充剂的人。目的：报告不同剂量MTX治疗肺结节病的疗效和耐受性，而不补充叶酸。方法：回顾性分析接受不同剂量MTX治疗≥ 3个月的肺结节病患者。主要结果是MTX治疗前后高分辨率计算机断层扫描（HRCT）的变化。其他疗效参数包括SGRQ评分、泼尼松剂量变化、停药和无复发生存期。还分析了反应相关因素和安全性结局。结果如下：经HRCT评估，49例（81.7%）患者为MTX应答者，不同剂量组间临床应答率无显著差异。缓解者的健康相关生活质量（HRQL）明显改善，SGRQ评分从16.7（IQR：7.9-26.4）降至10.7（IQR：4.8-19.3）（P=0.029）。在“反应者”组中证实了皮质类固醇节省效应（P
Background: Pulmonary sarcoidosis patients who get disease progression despite corticosteroid treatment or can't tolerate corticosteroid required second-line drug. Methotrexate (MTX) is the most widely used in our clinical practice. Data on its safety and efficacy at different doses are still limited, especially for those without folic acid supplements. Objective: To report effectiveness of different MTX dosages and tolerability of MTX in pulmonary sarcoidosis without folic acid supplements. Methods: A retrospective study on pulmonary sarcoidosis patients receiving MTX therapy with various dose >= 3 months was conducted. The primary outcome was change in high-resolution computed tomography (HRCT) before and after MTX therapy. Other efficacy parameters included SGRQ score, prednisone dose change, discontinuation and relapse-free survival. Response-linked factors and safety outcomes were also analyzed. Results: Overall, 49 patients (81.7%) were assessed as MTX responders by HRCT and there was no significant difference in clinical response rate among three groups with different doses. The health-related quality of life (HRQL) of the responders improved obviously, which was evidenced by SGRQ score declining from 16.7(IQR: 7.9-26.4) to 10.7(IQR: 4.8-19.3) (P=0.029). The corticosteroids sparing effect was confirmed in "responders" group (P