Division of Rheumatology, University Hospital Frankfurt, Goethe University , Frankfurt am Main , Germany.
Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine and Pharmacology TMP , Frankfurt am Main , Germany.
Scand J Rheumatol. 2019 Sep;48(5):375-382. doi: 10.1080/03009742.2019.1600717. Epub 2019 Jul 16.
: Randomized trials have shown that concomitant methotrexate (MTX) augments the effectiveness of tumour necrosis factor (TNF) inhibitors in rheumatoid arthritis (RA), but its benefit in psoriatic arthritis (PsA) has not been demonstrated. The goal of this study was to examine whether the impact of concomitant MTX on therapeutic outcomes in patients with PsA was similar to its effects in RA. : We used data from highly comparable and concurrent observational studies of patients with PsA (N = 1424) or RA (N = 3148) who initiated adalimumab therapy during routine clinical care. The 28-joint Disease Activity Score (DAS28) and patient-reported pain scores were evaluated in patients who received 24 months of continuous treatment with adalimumab monotherapy or adalimumab + MTX and in patients who initiated or stopped concomitant MTX during ongoing adalimumab therapy. : Twenty-four months of continuous treatment with adalimumab + MTX was superior to adalimumab monotherapy in RA patients, while no significant difference was observed in patients with PsA. RA patients who added MTX during the study showed significant individual improvements in DAS28 and pain scores at 6 months after the change in therapy, while those who removed MTX had slight increases in disease activity. In contrast, in patients with PsA, neither initiation nor removal of MTX during continuous adalimumab therapy had a significant effect on therapeutic outcomes. : Addition of MTX to adalimumab confers further therapeutic benefit in patients with RA, but not in those with PsA, suggesting differences in MTX effects in these two patient populations. Clinicaltrials.gov NCT01078090, NCT01077258, NCT01111240.
: 随机试验表明，肿瘤坏死因子（TNF）抑制剂与甲氨蝶呤（MTX）联合使用可增强其在类风湿关节炎（RA）中的疗效，但在银屑病关节炎（PsA）中的疗效尚未得到证实。本研究的目的是探讨 MTX 对 PsA 患者治疗效果的影响是否与 RA 相似。 : 我们使用了来自高度可比和同时进行的观察性研究的数据，这些研究涉及接受阿达木单抗治疗的 PsA（N=1424）或 RA（N=3148）患者。在接受阿达木单抗单药或阿达木单抗+MTX 24 个月连续治疗的患者以及在阿达木单抗治疗期间开始或停止联合 MTX 的患者中，评估了 28 关节疾病活动度评分（DAS28）和患者报告的疼痛评分。 : 在 RA 患者中，24 个月的连续 MTX+阿达木单抗治疗优于阿达木单抗单药治疗，而在 PsA 患者中则无显著差异。在研究期间添加 MTX 的 RA 患者在治疗方案改变后 6 个月时 DAS28 和疼痛评分显著改善，而停用 MTX 的患者疾病活动度略有增加。相比之下，在接受连续阿达木单抗治疗的 PsA 患者中，添加或停用 MTX 对治疗结果均无显著影响。 : 在 RA 患者中，添加 MTX 可进一步提高阿达木单抗的疗效，但在 PsA 患者中则不然，这表明 MTX 在这两种患者人群中的作用存在差异。Clinicaltrials.gov NCT01078090、NCT01077258、NCT01111240。
