Yocum D E
Department of Medicine, Arizona Arthritis Center, University of Arizona, Tucson, 85724, USA.
Br J Rheumatol. 1996 Sep;35 Suppl 2:19-23. doi: 10.1093/rheumatology/35.suppl_2.19.
The role of combination therapy in rheumatoid arthritis (RA) is increasing with the development of new treatment modalities. Past combinations of slow-acting anti-rheumatic drugs resulted in either excessive side-effects or lack of efficacy over single-agent therapy. However, refined methodology and a better understanding of the mechanism of action of newer agents have led to improved combinations, which appear more promising. In particular, in a 6 month, randomized, double-blind trial, the combination of cyclosporin (CyA) with methotrexate was found to be more efficacious than methotrexate alone, providing enhanced clinical benefit, without evidence of increased adverse events. The mean final dose of 2.97 mg/kg per day CyA in combination was lower than that required for CyA monotherapy. Further, a new formulation of CyA, with improved bioavailability, should provide enhanced efficacy and an acceptable safety profile, not only as monotherapy but also in combination with agents such as methotrexate. These developments offer new hope to patients with progressive RA, which is unresponsive to conventional therapy.
随着新治疗方式的发展，联合疗法在类风湿关节炎（RA）中的作用日益增强。过去，慢作用抗风湿药物的联合使用要么导致副作用过大，要么与单药治疗相比缺乏疗效。然而，改进的方法学以及对新型药物作用机制的更好理解促成了更优的联合方案，这些方案似乎更具前景。特别是，在一项为期6个月的随机双盲试验中，发现环孢素（CyA）与甲氨蝶呤联合使用比单独使用甲氨蝶呤更有效，能提供更大的临床益处，且无不良事件增加的迹象。联合使用时CyA的平均最终日剂量为2.97毫克/千克，低于环孢素单药治疗所需剂量。此外，一种生物利用度更高的环孢素新制剂不仅作为单药治疗，而且与甲氨蝶呤等药物联合使用时，都应能提高疗效并具有可接受的安全性。这些进展为对传统治疗无反应的进展性RA患者带来了新希望。
