Jobanputra P, Wilson J, Douglas K, Burls A
Department of Public Health and Epidemiology, University of Birmingham, Edgbaston, Birmingham, UK.
Rheumatology (Oxford). 2004 Feb;43(2):206-10. doi: 10.1093/rheumatology/keh003. Epub 2003 Aug 15.
To determine the current disease-modifying anti-rheumatic drug (DMARD) preferences of UK consultant rheumatologists.
A questionnaire was sent in May 2002. We asked which DMARD(s) was most frequently preferred first and sought the most typical sequence of DMARDs, including DMARD combinations. Also we determined the extent to which prognostic and other factors influenced treatment choices. Comments were invited, written responses abstracted and key themes identified.
After two mailings, 331 (of 460; 72%) suitable questionnaires were returned. Ninety-five per cent (315/331) preferred methotrexate (154, 46.5%) or sulphasalazine (144, 43.5%) or either of these two (17, 5%) as first-choice agent. Of those who chose methotrexate first, 80% (123/154) ranked sulphasalazine second, 45% (55/123) combined sulphasalazine and methotrexate and 49% (27/55) then added hydroxychloroquine to this combination, in active disease. Of those who chose sulphasalazine first, 95% (137/144) ranked methotrexate second, 75% (113/150) preferring methotrexate monotherapy and 12% (18/150) the combination with sulphasalazine. Rheumatologists who preferred sulphasalazine first more commonly used subsequent DMARDs singly than those who started with methotrexate (P < 0.0001). Leflunomide was more commonly preferred than intramuscular gold as third choice (52/145 vs 29/145; P < 0.003). The most popular sequence of DMARDs was methotrexate or sulphasalazine, singly or in combination, leflunomide, intramuscular gold and anti-tumour necrosis factor therapy. Poor prognostic factors influenced DMARD choice, but patient occupation and drug costs did not.
Methotrexate has displaced other DMARDs, especially sulphasalazine, as agent of first choice and newer agents have displaced older DMARDs. Whether the expressed preference for particular DMARDs accurately reflects actual use, and is optimal in rheumatoid arthritis, remains to be determined.
确定英国风湿病专科顾问医生目前对改善病情抗风湿药（DMARD）的偏好。
2002年5月发放了一份调查问卷。我们询问哪种DMARD最常被首选，以及DMARD的最典型用药顺序，包括DMARD联合用药情况。我们还确定了预后因素和其他因素对治疗选择的影响程度。邀请医生发表意见，提取书面回复并确定关键主题。
经过两次邮寄，共收回460份合适问卷中的331份（72%）。95%（315/331）的医生首选甲氨蝶呤（154人，46.5%）或柳氮磺胺吡啶（144人，43.5%）或这两种药物中的任意一种（17人，5%）作为首选药物。在那些首选甲氨蝶呤的医生中，80%（123/154）将柳氮磺胺吡啶列为第二选择，45%（55/123）将柳氮磺胺吡啶与甲氨蝶呤联合使用，49%（27/55）在疾病活动期在此联合用药基础上加用羟氯喹。在那些首选柳氮磺胺吡啶的医生中，95%（137/144）将甲氨蝶呤列为第二选择，75%（113/150）更喜欢甲氨蝶呤单药治疗，12%（18/150）选择甲氨蝶呤与柳氮磺胺吡啶联合使用。首选柳氮磺胺吡啶的风湿病医生比首选甲氨蝶呤的医生更常单独使用后续的DMARD（P < 0.0001）。来氟米特作为第三选择比肌肉注射金更受青睐（52/145对29/145；P < 0.003）。最常用的DMARD用药顺序是甲氨蝶呤或柳氮磺胺吡啶，单独使用或联合使用，然后是来氟米特、肌肉注射金和抗肿瘤坏死因子治疗。不良预后因素会影响DMARD的选择，但患者职业和药物费用则不会。
甲氨蝶呤已取代其他DMARD，尤其是柳氮磺胺吡啶，成为首选药物，新型药物也已取代了旧型DMARD。对于特定DMARD的这种偏好表达是否准确反映实际使用情况，以及在类风湿关节炎中是否为最佳选择，仍有待确定。
