Increasing methotrexate effect with increasing dose in the treatment of resistant rheumatoid arthritis.
Increasing methotrexate effect with increasing dose in the treatment of resistant rheumatoid arthritis.
复制标题
治疗难治性类风湿性关节炎时，甲氨蝶呤的疗效随着剂量的增加而增强。
作者：
D. Furst;R. Koehnke;L. Burmeister;J. Kohler;I. Cargill
46例顽固性类风湿性关节炎患者进入一项试验，包括2周住院期加16周随机双盲平行研究，比较安慰剂、5 mg/m2和10 mg/m2每周口服甲氨蝶呤（MTX）。另外6例患者给予20 mg/m2 MTX，导致毒性，但不是疗效分析。所有患者的金或D-青霉胺均“失败”。发现11个结局变量中的5个存在线性剂量反应关系（安慰剂vs 5 mg/m2 vs 10 mg/m2）：患者疼痛和患者总体量表、医生总体量表、关节压痛计数和日常生活活动量表（各P <0.05）。胃肠道毒性（p = 0.002）、消化不良（p <0.03）和口腔炎（p <0.09）在MTX中更常见，尽管不显著，但总体趋势是剂量毒性关系。
Forty-six patients with recalcitrant rheumatoid arthritis entered a trial encompassing a 2-week inpatient period plus a 16-week, randomized double blind, parallel study comparing placebo, 5 mg/m2 and 10 mg/m2 oral weekly methotrexate (MTX). An additional 6 patients, given 20 mg/m2 MTX, contributed to the toxicity, but not the efficacy analysis. All patients had "failed" either gold or D-penicillamine. A linear dose response relationship (placebo vs 5 mg/m2 vs 10 mg/m2) was found for 5 of 11 outcome variables: patient pain and patient global scale, physician global scale, joint tenderness count and activity of daily living scale (p less than 0.05 for each). Gastrointestinal toxicity (p = 0.002), dyspepsia (p less than 0.03) and stomatitis (p less than 0.09) occurred more commonly with MTX, and a general trend, although not significant, was found toward a dose toxicity relationship.