دورية أكاديمية
Effectiveness of methotrexate and leflunomide as corticoid-sparing drugs in patients with polymyalgia rheumatica.
| العنوان: | Effectiveness of methotrexate and leflunomide as corticoid-sparing drugs in patients with polymyalgia rheumatica. |
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| المؤلفون: | Vinicki JP; Sección Reumatología, Hospital de Quilmes, Buenos Aires, Argentina., Cusa A; IARI, Buenos Aires, Argentina., Domingo D; HIGA Luisa Cravenna de Gandulfo, Buenos Aires, Argentina., Velasco Zamora JL; Instituto de Investigaciones Clínicas de Quilmes, Buenos Aires, Argentina., Magri S; Unidad de Reumatología, Hospital Italiano de La Plata, Buenos Aires, Argentina., Brigante A; Servicio de Reumatología, Sanatorio Güemes, Buenos Aires, Argentina., Schmid MM; Sección Reumatología, Hospital Llano, Corrientes, Argentina., Ávila P; Sección Reumatología, Hospital de Quilmes, Buenos Aires, Argentina., Zamora N; Sección Reumatología, HIGA San José, Buenos Aires, Argentina., Sorrentino L; Servicio de Reumatología, Sanatorio Güemes, Buenos Aires, Argentina., Rodriguez AM; CEMIC, Sección Reumatología e Inmunología, Buenos Aires, Argentina., Linarez M; OSPM, Unidad de Reumatología, Buenos Aires, Argentina., Pisoni C; CEMIC, Sección Reumatología e Inmunología, Buenos Aires, Argentina., Costi C; Servicio de Reumatología, HIGA San Martín de La Plata, Buenos Aires, Argentina., Rodriguez Gil G; Unidad de Reumatología, Hospítal Municipal Dr Leónidas Lucero, Buenos Aires, Argentina., Spinetto MA; Centro Médico Privado, Buenos Aires, Argentina., Paris VU; Unidad de Reumatología, Hospital Escuela de Agudos Dr Ramón Madariaga, Misiones, Argentina., Perrotta N; Servicio de Reumatología, Hospital Dr César Milstein, Buenos Aires, Argentina., Maliandi MDR; Unidad de Reumatología, Sanatorio Garay, Santa Fe, Argentina., Rillo O; Sección Reumatología, Hospital Ignacio Pirovano, Buenos Aires, Argentina., Pena C; Servicio de Reumatología, HIGA San Martín de La Plata, Buenos Aires, Argentina., Got J; Unidad de Reumatología, Instituto Médico HUMANITAS, Chaco, Argentina., Cavallasca J; Sección Reumatología, Hospital José Bernardo Iturraspe, Santa Fe, Argentina., Machado Escobar M; Sección Reumatología, Hospital Eva Perón, Tucumán, Argentina., Iturralde C; Servicio de Reumatología, HIGA Dr Oscar Alende, Mar del Plata, Argentina., Martire MV; Servicio de Reumatología, HIGA San Roque de Gonnet de La Plata, Buenos Aires, Argentina., Tessel R; Servicio de Reumatología, Hospital Señor del Milagro, Salta, Argentina., Chocobar NS; Sección Reumatología, Hospital de Quilmes, Buenos Aires, Argentina., Alarcon G; Division of Clinical Immunology and Rheumatology, Department of Medicine, Marnix E. Heersink School of Medicine, The University of Alabama at Birmingham, United States. |
| المصدر: | Rheumatology advances in practice [Rheumatol Adv Pract] 2024 Mar 21; Vol. 8 (2), pp. rkae033. Date of Electronic Publication: 2024 Mar 21 (Print Publication: 2024). |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Oxford University Press Country of Publication: England NLM ID: 101736676 Publication Model: eCollection Cited Medium: Internet ISSN: 2514-1775 (Electronic) Linking ISSN: 25141775 NLM ISO Abbreviation: Rheumatol Adv Pract Subsets: PubMed not MEDLINE |
| أسماء مطبوعة: | Publication: [Oxford] : Oxford University Press, [2017]- |
| مستخلص: | Objectives: The need for glucocorticoid-sparing drugs (GCSD) remains an important issue and is an unmet need in the treatment of polymyalgia rheumatica (PMR). We therefore aimed to assess the effectiveness and safety of methotrexate (MTX) and of leflunomide (LEF) in daily clinical practice in PMR patients from Argentina. Methods: A multicentre and observational study (medical records review) of PMR patients seen between 2007 and 2023, who had at least three months of follow-up after starting a GCSD, either MTX or LEF, was performed. Results are expressed as medians and interquartile ranges [25th-75th (IQR)] for continuous variables and percentages for categorical ones. The two treatment groups were compared using χ 2 test for categorical variables, Mann-Whitney U test for continuous variables and the log-rank test for time-to-event data. Crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using logistic regression. In all cases, a p -value <0.05 was considered statistically significant. Results: One-hundred and eighty-six patients (79% female) with a median age of 72 years (IQR, 65-77 years) were included. One-hundred and forty-three patients (77%) were prescribed MTX (15, IQR 10-15) and 43 (23%) LEF (20 mg, fixed dose). Flare-ups (relapses and recurrences) occurred in 13 patients (7%) and were comparable between both groups. Persistent GCSD intake was observed in 145 patients (78%). Glucocorticoid (GC) withdrawal was achieved in 67 of these 145 patients (46%) and this occurred more frequently in the LEF group ( P = 0.001 ). Furthermore, time until prednisone discontinuation was shorter in the LEF-treated patients (4.7 months, IQR 3-20 on LEF versus 31.8 months, IQR 10-82 on MTX, P = 0.000 ). Remission was found more frequently in the LEF group ( P = 0.003 ). In the multivariate analysis, the probability of remission was higher with LEF therapy ( P = 0.010) and this finding persisted in the subgroup analysis who were followed up < 40 months (OR 3.12, 95% CI = 1.30-7.47, P = 0.011). Conclusions: This study demonstrated the clinical effectiveness of LEF and even its superiority in achieving remission when compared with MTX as GCSD in PMR patients. Further research is needed to support these findings. (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Society for Rheumatology.) |
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| فهرسة مساهمة: | Keywords: glucocorticoid-sparing drugs; glucocorticoids; leflunomide; methotrexate; observational study; polymyalgia rheumatica; recurrence; relapse; remission |
| تواريخ الأحداث: | Date Created: 20240401 Latest Revision: 20240403 |
| رمز التحديث: | 20240403 |
| مُعرف محوري في PubMed: | PMC10978571 |
| DOI: | 10.1093/rap/rkae033 |
| PMID: | 38560643 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 2514-1775 |
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| DOI: | 10.1093/rap/rkae033 |