医学
类风湿性关节炎
托法替尼
Janus激酶抑制剂
内科学
甲氨蝶呤
贾纳斯激酶
风湿病
痹症科
队列
细胞因子
作者
Kosuke Ebina,Tôru Hirano,Yukihide Maeda,Yasutaka Okita,Yuki Etani,Makoto Hirao,Wataru Yamamoto,Motomu Hashimoto,Koichi Murata,Akira Ōnishi,Sadao Jinno,Ryota Hara,Yonsu Son,Hideki Amuro,Takuya Kotani,Hideyuki Shiba,Masaki Katayama,Keiichi Yamamoto,Atsushi Kumanogoh,Seiji Okada,Ken Nakata
摘要
ABSTRACT Objectives This multicenter, retrospective study evaluated the effectiveness of add-on methotrexate (MTX) or iguratimod (IGU) in patients with rheumatoid arthritis exhibiting an inadequate response to Janus kinase inhibitors (JAKis). Methods Forty-five patients were treated with new additional MTX (n = 22) or IGU (n = 23) and followed for 6 months. Patients’ background is as follows: age, 59.2 years; disease activity score of 28 joints with C-reactive protein (DAS28-CRP), 3.4; clinical disease activity index, 15.7; biological disease-modifying antirheumatic drug (DMARD)-switched cases, 77.8%; first JAKi cases, 95.6%; and JAKi treatment: tofacitinib (n = 25), baricitinib (n = 17), upadacitinib (n = 2), and peficitinib (n = 1) for 9.6 months. Results Thirty-five patients continued the combination therapy for 6 months without a significant change in concomitant glucocorticoid or other conventional synthetic DMARDs. DAS28-CRP (MTX, 3.6 to 2.6, p < 0.05; IGU, 3.3 to 2.1, p < 0.001) and clinical disease activity index (MTX, 16.7 to 8.8, p < 0.05; IGU, 14.6 to 6.5, p < 0.01) improved significantly from baseline. Using the 2019 European League Against Rheumatism criteria, 45.4% (MTX) and 39.1% (IGU) achieved moderate or good response and 40.9% (MTX) and 39.1% (IGU) achieved American College of Rheumatology 20% improvement criteria. Conclusions Adding MTX or IGU to inadequate responders of JAKi can be considered as a complementary treatment.
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