| Step-down approach using either cyclosporin A or methotrexate as maintenance therapy in early rheumatoid arthritis. | |
| | |
MedLine Citation:
|
PMID: 11932879 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
OBJECTIVE: To evaluate the feasibility and outcome of the step-down approach using either cyclosporin A (CSA) or methotrexate (MTX) as maintenance therapy following 6 months treatment with these 2 agents in combination in early, nonerosive rheumatoid arthritis (RA). METHODS: Fifty-seven patients younger than 65 years with early, nonerosive RA were first treated with CSA and MTX in combination for 6 months. They were then randomly stepped down to single-agent maintenance treatment for another 18 months. Safety, clinical efficacy, survival on treatment, and radiographic progression were evaluated. RESULTS: When being treated with combination therapy, 7 of the 57 patients (12.3%) withdrew because of adverse events. Of the remaining 50 patients, 42 (84.0%) were American College of Rheumatology (ACR) 20% responders, 30 (60.0%) were ACR 50% responders, and 23 (46.0%) were ACR 70% responders. At month 6, 22 patients were randomized to CSA and 27 to MTX. During this trial period, the treatment was discontinued by 16 patients taking CSA (mainly because of loss of efficacy) and by 4 taking MTX. At month 24, the probability (+/- SEM) of survival on treatment was 0.273 +/- 0.09 for CSA and 0.852 +/- 0.07 for MTX. Of the 6 CSA patients who completed the trial, 4 (66.7%) were ACR 20% responders, and 3 (50%) were both ACR 50% and ACR 70% responders. Of the 23 completers in the MTX arm, 21 (91.3%) were ACR 20% responders, 18 (78.3%) were ACR 50%, and 10 (43.5%) were ACR 70% responders. The treatment was not responsible for severe adverse events. Radiography showed a slow progression in the damage score and number of eroded joints in both treatment groups. CONCLUSION: Stepping down to single agent maintenance therapy following 6 months of combination treatment with CSA and MTX in early RA was only successful with MTX. Because this treatment did not prevent some radiographic progression, other approaches (e.g., step-up approach) may be more appropriate in early RA. |
| | |
Authors:
|
Antonio Marchesoni; Norma Battafarano; Marco Arreghini; Raffaele Pellerito; Maria Cagnoli; Porziana Prudente; Alfonso Cerase; Francesco Priolo; Sergio Tosi |
Related Documents
:
|
23374649 - Biolimus-eluting biodegradable polymer-coated stent versus durable polymer-coated sirol... 23599849 - Bedside teaching on time to disposition improves length of stay for critically-ill emer... 11964959 - Infliximab as a novel therapy for pediatric ulcerative colitis. 3915889 - Rectal administration of tenoxicam for the treatment of rheumatoid arthritis and arthro... 23741689 - Antiadhesive effect and safety of oxidized regenerated cellulose after thyroidectomy: a... 20693809 - Addition of infliximab to standard therapy for anca-associated vasculitis. 21091329 - Ondansetron is safe and effective for prehospital treatment of nausea and vomiting by p... 22972879 - Perioperative oral administration of cystine and theanine enhances recovery after dista... 16409169 - Canadian multi-institutional survey of immune tolerance therapy (itt) -- experience wit... |
Publication Detail:
|
Type: Clinical Trial; Journal Article; Randomized Controlled Trial |
Journal Detail:
|
Title: Arthritis and rheumatism Volume: 47 ISSN: 0004-3591 ISO Abbreviation: Arthritis Rheum. Publication Date: 2002 Feb |
Date Detail:
|
Created Date: 2002-04-04 Completed Date: 2002-04-18 Revised Date: 2004-11-17 |
Medline Journal Info:
|
Nlm Unique ID: 0370605 Medline TA: Arthritis Rheum Country: United States |
Other Details:
|
Languages: eng Pagination: 59-66 Citation Subset: AIM; IM |
Affiliation:
|
G. Pini Orthopaedic Institute, Milan, Italy. marchesoni@g-pnin.unimi.it |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adult Aged Antirheumatic Agents / administration & dosage* Arthritis, Rheumatoid / drug therapy* Arthrography Cyclosporine / administration & dosage* Dose-Response Relationship, Drug Drug Administration Schedule Drug Therapy, Combination Feasibility Studies Female Humans Joints / pathology, physiopathology Male Methotrexate / administration & dosage* Middle Aged |
| Chemical | |
Reg. No./Substance:
|
0/Antirheumatic Agents; 59-05-2/Methotrexate; 59865-13-3/Cyclosporine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Structural effect of avocado/soybean unsaponifiables on joint space loss in osteoarthritis of the hi...
Next Document: The number of deformed joints as a surrogate measure of damage in rheumatoid arthritis.