Capell Hilary
Centre for Rheumatic Disease, Royal Infirmary, Glasgow, Scotland.
J Rheumatol Suppl. 2002 Nov;66:38-43.
Longterm safety and efficacy of disease modifying antirheumatic drugs (DMARD) have been challenging to assess. There are few studies that have evaluated patient outcome beyond 5 years. As patients may receive several DMARD over the course of their disease a long with nonsteroidal antiinflammatory drugs, corticosteroids, and other drugs for comorbidities, it is difficult to design and implement a trial to define a specific drug's longterm effect. Based on the findings of several key studies, however, it does appear that DMARD are safe when taken longterm, and that they are more likely to be discontinued because of inefficacy than toxicity. Although DMARD are often discontinued because of lack of efficacy, 12 year data suggest that DMARD can provide benefit over this period. The toxicity profiles vary significantly between DMARD. In addition, the time during therapy when the majority of these adverse effects most frequently appear is DMARD-specific. Prospective studies are needed to further clarify longterm safety and efficacy of the newer DMARD.
评估改善病情抗风湿药物（DMARD）的长期安全性和疗效具有挑战性。很少有研究对5年以上的患者结局进行评估。由于患者在病程中可能会同时使用几种DMARD以及非甾体抗炎药、皮质类固醇和其他用于治疗合并症的药物，因此很难设计和实施一项试验来确定特定药物的长期效果。然而，根据几项关键研究的结果，长期服用DMARD似乎是安全的，而且它们更有可能因无效而非毒性而停药。尽管DMARD常常因缺乏疗效而停药，但12年的数据表明，DMARD在此期间可以带来益处。不同DMARD的毒性特征差异很大。此外，这些不良反应最常出现的治疗时间因DMARD而异。需要进行前瞻性研究以进一步阐明新型DMARD的长期安全性和疗效。
