DRUG-THERAPY OF THE IDIOPATHIC INFLAMMATORY MYOPATHIES - PREDICTORS OF RESPONSE TO PREDNISONE, AZATHIOPRINE, AND METHOTREXATE AND A COMPARISON OF THEIR EFFICACY
DRUG-THERAPY OF THE IDIOPATHIC INFLAMMATORY MYOPATHIES - PREDICTORS OF RESPONSE TO PREDNISONE, AZATHIOPRINE, AND METHOTREXATE AND A COMPARISON OF THEIR EFFICACY
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DOI：
10.1016/0002-9343(93)90148-i
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发表时间：
1993-04-01
影响因子：
5.9
通讯作者：
MILLER, FW
中科院分区：
文献类型：
--
作者：
JOFFE, MM;LOVE, LA;MILLER, FW
目的：确定影响特发性炎症性肌病患者对泼尼松、甲氨蝶呤或硫唑嘌呤治疗反应的相关因素，并比较这些药物的疗效。方法：收集113例符合特发性炎症性肌病诊断标准的成年患者的资料。根据临床和实验室标准，患者被分类为对每个治疗试验完全有效、部分有效或完全无效。结果：临床组、某些肌炎特异性自身抗体的存在以及从发病到诊断的时间影响这些治疗药物的完全临床应答率。包涵体肌炎患者对其他药物泼尼松的反应相对较差：43%的患者对泼尼松没有临床反应，没有人对任何药物完全有效。对氨基酰-tRNA合成酶或信号识别颗粒蛋白有自身抗体的患者可能对泼尼松有部分反应，但不是全部。诊断延迟时间较长(大于18个月)的患者没有一例完全有效，而诊断延迟时间较短(小于3个月)的患者中，这一比例为34%。一名患者对泼尼松第一疗程的反应预测了对泼尼松和硫唑嘌呤的后续反应比对甲氨蝶呤的反应更好。男性对甲氨蝶呤的反应比女性更好。在某些亚组患者中，甲氨蝶呤的疗效优于硫唑嘌呤或强的松再治疗。结论：确定肌炎患者的临床分组、自身抗体状态以及从发病到确诊的时间为预测临床疗效提供了有用的信息，在设计未来的治疗试验时应考虑这些因素。甲氨蝶呤治疗可能优于硫唑嘌呤或单独使用进一步的类固醇治疗，对于某些对泼尼松初始适当疗程不完全有效的患者。
PURPOSE: To identify factors associated with responses to treatment with prednisone, methotrexate, or azathioprine in patients with idiopathic inflammatory myopathy, and to compare the efficacy of these drugs.PATIENTS AND METHODS: Data were collected on 113 adult patients meeting criteria for definite idiopathic inflammatory myopathy in this retrospective cohort study. Patients were categorized as responding completely, partially, or not at all to each therapeutic trial based upon clinical and laboratory criteria.RESULTS: Clinical group, presence of certain myositis-specific autoantibodies, and time from disease onset to diagnosis influenced rates of complete clinical response to these therapeutic agents. Patients with inclusion body myositis responded comparatively poorly to prednisone the other drugs: 43% had no clinical response to prednisone and none responded completely to any medication. Patients with autoantibodies to aminoacyl-tRNA synthetases or to signal recognition particle proteins were likely to respond partially, but not completely, to prednisone. No patient with a long delay to diagnosis (greater than 18 months) responded completely, compared with 34% of those with a short delay (less than 3 months). A patient's response to the first course of prednisone predicted subsequent responses to prednisone and to azathioprine better than response to methotrexate. Men responded to methotrexate better than women. Among certain subgroups of patients, responses to methotrexate were better than to either azathioprine or retreatment with prednisone.CONCLUSION: Determining the clinical group, autoantibody status, and time from disease onset to diagnosis of patients with myositis provides useful information in predicting clinical responses to therapy, and these factors should be considered in designing future therapeutic trials. Methotrexate therapy may be superior to either azathioprine or further steroid treatment alone in certain patients who do not respond completely to an initial adequate course of prednisone.