Are switches from oral to subcutaneous methotrexate or addition of ciclosporin to methotrexate useful steps in a tight control treatment strategy for rheumatoid arthritis? A post hoc analysis of the CAMERA study

被引：40

作者：

Bakker, M. F. ^{[1
]}

Jacobs, J. W. G. ^{[1
]}

Welsing, P. M. J. ^{[1
,2
]}

van der Werf, J. H. ^{[3
]}

Linn-Rasker, S. P. ^{[4
]}

van der Veen, M. J. ^{[5
]}

Lafeber, F. P. J. G. ^{[1
]}

Bijlsma, J. W. J. ^{[1
]}

机构：

[1] Univ Med Ctr Utrecht, Dept Rheumatol & Clin Immunol, NL-3508 GA Utrecht, Netherlands

[2] Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, NL-3508 GA Utrecht, Netherlands

[3] Diakonessen Hosp, Dept Rheumatol, Utrecht, Netherlands

[4] Meander Med Ctr, Dept Rheumatol, Amersfoort, Netherlands

[5] St Jansdal Hosp, Dept Rheumatol, Harderwijk, Netherlands

来源：

ANNALS OF THE RHEUMATIC DISEASES | 2010年 / 69卷 / 10期

关键词：

COMBINATION THERAPY; CONTROLLED-TRIAL;

D O I：

10.1136/ard.2009.124065

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

Objective To investigate the effects of a switch from oral methotrexate (MTX) to subcutaneous MTX (scMTX) or adding ciclosporin to oral MTX with a simultaneous reduction of the MTX dose, in case of adverse events (AE) or insufficient effect (IE) in rheumatoid arthritis (RA). Methods The tight control treatment arm of the Computer Assisted Management in Early RA (CAMERA) trial was evaluated. The change in 28-joint Disease Activity Score (DAS28) after taking scMTX (over 1 month) or adding ciclosporin (over 3 months) was compared to the average monthly change in the preceding 3 months. Analyses were performed separately for strategy steps because of AE or IE. Results Of 151 patients, 57 needed the scMTX strategy step (21 because of AE, 36 because of IE) and 40 the following ciclosporin strategy step (20 and 20, respectively). The decrease in DAS28 after taking the scMTX strategy step was 0.30 points (p<0.05); no significant change in DAS28 was seen after the ciclosporin strategy step. In both strategy steps for AE or IE, quite similar observations were made. Of the patients who took the scMTX strategy step, 63% showed improvement. Conclusion scMTX seems a useful treatment step after oral MTX in a tight control strategy, whereas the ciclosporin step seems ineffective.

引用

页码：1849 / 1852

页数：4

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