Klein Ariane
Allgemeine Kinder- und Jugendmedizin, Asklepios Klinik Sankt Augustin GmbH, Arnold-Janssenstraße 29, 53757, Sankt Augustin, Deutschland.
Z Rheumatol. 2019 Sep;78(7):599-609. doi: 10.1007/s00393-019-0645-4.
In polyarticular juvenile idiopathic arthritis, methotrexate (MTX) is still used as first-line treatment. In case of insufficient response or intolerance, a number of biologics are now available. This faces physicians with challenging choices. Biologics are often combined with MTX, although in JIA there is little evidence and inconsistent results from various studies. In rheumatoid arthritis, combination therapy with tumor necrosis factor (TNF) inhibitors has been associated with higher efficacy. Tocilizumab appears to be highly effective as a monotherapy. MTX has a protective effect on the formation of anti-drug antibodies, which is particularly important for the use of anti-TNF antibodies. This could also be observed in children. For golimumab, combination with MTX is mandatory according to its approval, as is the cause for abatacept. With regard to tolerability, apart from the classic side effects of MTX, there are no other significant differences concerning the combination of MTX and biologics. In case of MTX intolerance, leflunomide may be considered as an (unapproved) alternative.
在多关节型幼年特发性关节炎中，甲氨蝶呤（MTX）仍被用作一线治疗药物。若疗效不佳或出现不耐受情况，现在有多种生物制剂可供选择。这给医生带来了具有挑战性的选择。生物制剂通常与MTX联合使用，尽管在幼年特发性关节炎中，各种研究的证据很少且结果不一致。在类风湿性关节炎中，肿瘤坏死因子（TNF）抑制剂联合治疗已显示出更高的疗效。托珠单抗作为单一疗法似乎非常有效。MTX对抗药物抗体的形成具有保护作用，这对于抗TNF抗体的使用尤为重要。在儿童中也可观察到这一点。对于戈利木单抗，根据其批准情况，与MTX联合使用是强制性的，阿巴西普也是如此。关于耐受性，除了MTX的经典副作用外，MTX与生物制剂联合使用没有其他显著差异。如果对MTX不耐受，来氟米特可被视为一种（未获批准的）替代药物。
