Safety and retention of combination triple disease-modifying anti-rheumatic drugs in new-onset rheumatoid arthritis
Safety and retention of combination triple disease-modifying anti-rheumatic drugs in new-onset rheumatoid arthritis
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DOI：
10.1111/imj.12896
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发表时间：
2015-12-01
影响因子：
2.1
通讯作者：
Thomas, R.
中科院分区：
文献类型：
--
作者：
Cummins, L.;Katikireddi, V. S.;Thomas, R.
虽然甲氨蝶呤(MTX)、柳氮磺胺吡啶(SSZ)和羟基氯喹(HCQ)三联疗法(三联疗法)的疗效已在临床试验中得到证实，但很少有研究在现实生活中检验其长寿情况。目的是评估一种三联抗风湿药物(DMARD)方案在新发类风湿性关节炎(RA)患者中的耐受性、持久性和有效性。根据反应驱动递增算法加强治疗，包括进展到来氟米特(LEF)或生物制剂。结果181例新发RA患者中，119例开始三联疗法。三联疗法的中位疗程为39周，最后一次随访时仍有23.5%的患者继续使用三联疗法，中位随访时间为104周。最后一次随访时，32%的患者继续接受任何三种DMARD联合治疗(包括LEF)，中位持续时间为70周。停用MTX、SSZ或HCQ中至少一种的原因是38%的患者出现不良反应，7%的患者出现缓解，28%的患者出现不完全反应。SSZ在最初的药物停药中因不良事件而占49%。继续三联治疗对缓解或低疾病活动度(LDA)的患者比例无显著影响。结论新发RA患者对三联疗法耐受性较好，中位数为39周。SSZ不耐受通常会降低三联疗法的寿命。对缓解或LDA的目标的治疗比DMARD继续治疗的次数更重要。
BackgroundWhile efficacy of combination treatment with methotrexate (MTX), sulfasalazine (SSZ) and hydroxychloroquine (HCQ) (triple therapy') has been shown in clinical trials, few studies have examined its longevity in a real-life setting.AimOur aim was to assess the tolerability, longevity and efficacy of a triple disease-modifying anti-rheumatic drug (DMARD) regimen initiated in new-onset rheumatoid arthritis (RA) patients.MethodsPatients who met 1987 American College of Rheumatology criteria for RA with disease duration less than 2years were offered triple therapy upon diagnosis. Treatment was intensified according to a response-driven step-up algorithm, which included progression to leflunomide (LEF) or a biologic agent.ResultsOf 181 new-onset RA patients, 119 commenced triple therapy. Median duration of triple therapy was 39weeks, and 23.5% remained on it at last follow up, with median follow up 104weeks. Continuous therapy with any three-DMARD combination (including LEF) occurred in 32% at last follow up, with median duration of 70weeks. Cessation of at least one of MTX, SSZ or HCQ occurred because of an adverse event in 38%, remission in 7% and incomplete response in 28% of patients. SSZ accounted for 49% of initial drug withdrawals for an adverse event. Continuation of three-drug therapy did not significantly influence the proportion of patients achieving remission or low disease activity (LDA).ConclusionsTriple therapy in new-onset RA was reasonably well tolerated, persisting for median 39weeks. SSZ intolerance commonly reduces longevity of triple therapy. Treating to the target of remission or LDA is more important than the number of DMARD continued.