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在类风湿性关节炎患者中,同时使用美洛昔康和甲氨蝶呤并不会明显增加隐匿性肾损伤和肝损伤的风险。

The concomitant use of meloxicam and methotrexate does not clearly increase the risk of silent kidney and liver damages in patients with rheumatoid arthritis.

作者信息

Park Hee-Jin, Park Min-Chan, Park Yong-Beom, Lee Soo-Kon, Lee Sang-Won

机构信息

Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.

出版信息

Rheumatol Int. 2014 Jun;34(6):833-40. doi: 10.1007/s00296-013-2920-z. Epub 2013 Dec 22.

Abstract

We investigated whether the concomitant use of meloxicam and methotrexate might induce kidney and liver damages in patients with rheumatoid arthritis (RA). We enrolled 101 RA patients with normal kidney and liver functions taking meloxicam and methotrexate concomitantly for more than 6 months. Blood and urine tests were performed. Estimated glomerular filtration rate (eGFR) and liver stiffness measurement (LSM) were used for evaluating silent kidney and liver damages. Ultrasonography was also performed to exclude structural abnormalities. We adopted 90 mL/min/1.73 mm(2) and 5.3 kPa as the cutoff for an abnormal eGFR and LSM. The mean age (85 women) was 51.9 years. The mean eGFR was 97.0 mL/min/1.73 m(2) and the mean LSM was 4.7 kPa. The mean weekly dose of methotrexate was 13.4 mg. The mean weekly dose of methotrexate did not correlate with eGFR or LSM. Neither the cumulative dose of meloxicam or methotrexate nor the mean weekly dose of methotrexate showed the significant odds ratio or relative risk for abnormal eGFR and LSM values. The use of higher-dose MTX, above 15 mg per week, with meloxicam did not significantly increase the risk for abnormal LSM and eGFR (RR = 2.042, p = 0.185; RR = 0.473, p = 0.218). The concomitant use of meloxicam and MTX did not clearly increase the risk of silent kidney or liver damage in RA patients with normal laboratory results taking MTX and meloxicam concurrently for over 6 months.

摘要

我们调查了美洛昔康与甲氨蝶呤联合使用是否会在类风湿关节炎(RA)患者中导致肾脏和肝脏损害。我们纳入了101例肾功能和肝功能正常且同时服用美洛昔康和甲氨蝶呤超过6个月的RA患者。进行了血液和尿液检测。采用估计肾小球滤过率(eGFR)和肝脏硬度测量(LSM)来评估隐匿性肾脏和肝脏损害。还进行了超声检查以排除结构异常。我们采用90 mL/min/1.73 mm² 和5.3 kPa作为eGFR和LSM异常的临界值。平均年龄(85名女性)为51.9岁。平均eGFR为97.0 mL/min/1.73 m²,平均LSM为4.7 kPa。甲氨蝶呤的平均每周剂量为13.4 mg。甲氨蝶呤的平均每周剂量与eGFR或LSM无关。美洛昔康或甲氨蝶呤的累积剂量以及甲氨蝶呤的平均每周剂量均未显示出eGFR和LSM值异常的显著优势比或相对风险。每周使用高于15 mg的高剂量甲氨蝶呤与美洛昔康联合使用并未显著增加LSM和eGFR异常的风险(RR = 2.042,p = 0.185;RR = 0.473,p = 0.218)。对于实验室检查结果正常且同时服用甲氨蝶呤和美洛昔康超过6个月的RA患者,美洛昔康与甲氨蝶呤联合使用并未明显增加隐匿性肾脏或肝脏损害的风险。

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