Fries J F, Williams C A, Ramey D, Bloch D A
Department of Medicine, Stanford University School of Medicine, California.
Arthritis Rheum. 1993 Mar;36(3):297-306. doi: 10.1002/art.1780360303.
To compare the toxicities of commonly employed disease-modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (RA).
Toxicity Index scores, computed from symptoms, laboratory abnormalities, and hospitalizations attributable to DMARD therapy, were assessed in 2,747 patients with RA receiving 3,053 courses of 6 DMARDs and 1,309 courses of prednisone over 7,278 patient-years. Results were adjusted for severity of illness and other covariates.
Least toxic was hydroxychloroquine (mean +/- SEM score 1.38 +/- 0.15), followed by intramuscular gold (2.27 +/- 0.17) and the closely grouped D-penicillamine (3.38 +/- 0.36), methotrexate (3.82 +/- 0.35), and azathioprine (3.92 +/- 0.39). Auranofin (5.25 +/- 0.32) was most toxic, but this toxicity resulted from a high frequency of minor complications. Hospitalizations because of auranofin or hydroxychloroquine therapy were not noted. Prednisone (3.83 +/- 0.39) was of comparable toxicity, although it is likely that not all events of prednisone toxicity were captured. For reference, the toxicity of methotrexate and azathioprine was similar to that of the most toxic nonsteroidal antiinflammatory drugs (NSAIDs) (indomethacin 3.99, tolmetin sodium 3.96, and meclofenamate 3.86). Hydroxychloroquine showed less toxicity than the most commonly used prescription NSAIDs.
There are substantial differences in toxicity among DMARDs and less important differences in toxicity between specific DMARDs and specific NSAIDs.
比较类风湿关节炎（RA）中常用的改善病情抗风湿药（DMARDs）的毒性。
在2747例类风湿关节炎患者中评估了毒性指数评分，该评分根据DMARD治疗所致症状、实验室异常及住院情况计算得出，这些患者在7278患者年中接受了3053个疗程的6种DMARDs及1309个疗程的泼尼松治疗。对疾病严重程度及其他协变量进行了结果校正。
毒性最小的是羟氯喹（平均±标准误评分1.38±0.15），其次是肌肉注射金制剂（2.27±0.17）以及紧密相近组别的青霉胺（3.38±0.36）、甲氨蝶呤（3.82±0.35）和硫唑嘌呤（3.92±0.39）。金诺芬（5.25±0.32）毒性最大，但这种毒性是由高频率的轻微并发症所致。未发现因金诺芬或羟氯喹治疗而住院情况。泼尼松（3.83±0.39）毒性与之相当，尽管可能并非所有泼尼松毒性事件均被记录到。作为参考，甲氨蝶呤和硫唑嘌呤的毒性与毒性最大的非甾体抗炎药（NSAIDs）（吲哚美辛3.99、托美丁钠3.96和甲氯芬那酸3.86）相似。羟氯喹的毒性低于最常用的处方NSAIDs。
DMARDs之间毒性存在显著差异，但特定DMARDs与特定NSAIDs之间毒性差异较小重要性较低。
