EN PL
PRACA ORYGINALNA
Leczenie chorych na reumatoidalne zapalenie stawów metotreksatem w Polsce: retrospektywna analiza chorych w codziennej praktyce klinicznej
 
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Ukryj
 
Data nadesłania: 31-12-2017
 
 
Data ostatniej rewizji: 15-02-2018
 
 
Data akceptacji: 22-02-2018
 
 
Data publikacji online: 28-02-2018
 
 
Data publikacji: 28-02-2018
 
 
Reumatologia 2018;56(1):3-9
 
SŁOWA KLUCZOWE
DZIEDZINY
STRESZCZENIE
Objectives:
The aim of this study was to evaluate methotrexate (MTX) treatment administered by Polish rheumatologists in everyday practice.

Material and methods:
The study was based on a retrospective analysis of a cohort of 1957 patients with rheumatoid arthritis (RA). It was conducted among 100 rheumatologists, each of whom received 20 questionnaires and completed them based on the data from their rheumatoid arthritis patients.

Results:
Methotrexate was taken by 91% of patients, and 80% of them continued the treatment either as a monotherapy (65%) or concomitantly with other disease-modifying anti-rheumatic drugs. In 60% of the cases, therapy was initiated within six months of diagnosis. Dose modifications were observed in 76% of cases and were contingent on different factors, e.g. lack of efficacy, presence of adverse events. The most prevalent adverse events were nausea and vomiting, weakness, and elevated liver enzyme activity. The most common initial dose of MTX was 10 or 15 mg/week. An increase in dose to the maximum of 25 mg/week was observed in 36% of cases, with continuation for 27% of patients. Treatment interruption was noted in 21% of patients, predominantly due to MTX intolerance; however, in 13% of cases, it was due to patient choice.

Conclusions:
Methotrexate is the most common agent used to treat rheumatoid arthritis. Dose modifications are often applied to maximise efficacy and reduce adverse reactions, which could lead to withdrawal. Methotrexate is an effective drug for treatment of RA when used according to current recommendations. To optimise MTX therapy, regular medical visits are required.

 
REFERENCJE (30)
1.
Smolen JS, Landewé R, Bijlsma J, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis 2017; 76: 960-977.
 
2.
Gaujoux-Vialaa C, Gossecb L, Cantagrelc A, et al. Recommendations of the French Society for Rheumatology for managing rheumatoid arthritis. Joint Bone Spine 2014; 81: 287-297.
 
3.
Singh JA, Saag KG, Bridges SL Jr, et al. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Rheum 2016; 61: 1-26.
 
4.
Visser K, Katchamart W, Loza E, et al. Multinational evidence-based recommendations for the use of methotrexate in rheumatic disorders with a focus on rheumatoid arthritis: integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E Initiative. Ann Rheum Dis 2009; 68: 1086-1093.
 
5.
Molina J. Recommendations for the Use of MTX in RA. Reumatol Clin 2015; 11: 3-8.
 
6.
Bello AE, Perkins EL, Jay R, Efthimiou P. Recommendations for optimizing methotrexate treatment for patients with rheumatoid arthritis. Open Access Rheumatol 2017; 9: 67-79.
 
7.
Kłak A, Paradowska-Gorycka A, Kwiatkowska B, Raciborski F. Personalized medicine in rheumatology. Reumatologia 2016; 54: 177-186.
 
8.
Burmester GR, Pope JE. Novel treatment strategies in rheumatoid arthritis. Lancet 2017; 10: 2338-2348.
 
9.
Graudal N, Hubeck-Graudal T, Tarp S, et al. Effect of Combination Therapy on Joint Destruction in Rheumatoid Arthritis: A Network Meta-Analysis of Randomized Controlled Trials. PLOS One 2014; 9: e106408.
 
10.
Bakker MF, Jacobs JW, Welsing PM, et al. Early clinical response to treatment predicts 5-year outcome in RA patients: follow-up results from the CAMERA study. Ann Rheum Dis 2011; 70: 1099-1113.
 
11.
NICE commissioning guides. Support for commissioning for rheumatoid arthritis [CMG51] 01 June 2013 http://www.nice.org.uk/guidanc....
 
12.
Kulig M, Malec Z, Tłustochowicz W. Analiza leczenia ambulatoryjnego metotreksatem chorych na reumatoidalne zapalenie stawów. Reumatologia 2009; 47: 202-206.
 
13.
Nikolaisen C, Kvien TK, Mikkelsen K, et al. Contemporary use of disease-modifying drugs in the management of patients with early rheumatoid arthritis in Norway. Scand J Rheumatol 2009; 19: 1-6.
 
14.
Anderson JJ, Wells G, Verhoeven AC, Felson DT. Factors predicting response to treatment in rheumatoid arthritis: the importance of disease duration. Arthritis Rheum 2000; 43: 22-29.
 
15.
Saevarsdottir S, Wallin H, Seddighzadeh M, et al. Predictors of response to methotrexate in early DMARD naïve rheumatoid arthritis: results from the initial open-label phase of the SWEFOT trial. Ann Rheum Dis 2011; 70: 469-475.
 
16.
Świerkot J, Sokolik R, Gruszecka-Marczynska K, et al. Skuteczność leczenia i występowanie działań niepożądanych w trakcie terapii metotreksatem podawanym doustnie i podskórnie chorym na reumatoidalne zapalenie stawów. Reumatologia 2008; 46: 322-329.
 
17.
Nikiphorou E, Negoescu A, Fitzpatrick JD, et al. Indispensable or intolerable? Methotrexate in patients with rheumatoid and psoriatic arthritis: a retrospective review of discontinuation rates from a large UK cohort. Clin Rheumatol 2014; 33: 609-614.
 
18.
Curtis J, Bykerk V, Aassi M, Schiff M. Adherence and Persistence with Methotrexate in Rheumatoid Arthritis: A Systematic Review. J Rheumatol 2016; 43: 1997-2009.
 
19.
Lopez-Olivo MA, Siddhanamatha HR, Shea B, et al. Methotrexate for treating rheumatoid arthritis. Cochrane Database Syst Rev 2014; 10: CD000957.
 
20.
Bogas M. Methotrexate treatment in rheumatoid arthritis. Clin Rheumatol 2010; 29: 629-635.
 
21.
Coulson E, Saravanan V, Hamilton J, et al. Pneumococcal antibody levels after pneumovax in patients with rheumatoid arthritis on methotrexate. Ann Rheum Dis 2011; 70: 1289-1291.
 
22.
Micha R. Systematic Review and Meta-Analysis of Methotrexate Use and Risk of Cardiovascular Disease. Am J Cardiol 2011; 108: 1362-1370.
 
23.
Wasko MC, Dasgupta A, Hubert H, et al. Propensity-adjusted association of methotrexate with overall survival in rheumatoid arthritis. Arthritis Rheum 2013; 65: 334-342.
 
24.
Arena U, Stasi C, Mannoni A, et al. Liver stiffness correlates with methotrexate cumulative dose in patients with rheumatoid arthritis. Dig Liver Dis 2012; 44: 149-153.
 
25.
Rouhi A, Hazlewood G, Shaheen AA, et al. Prevalence and risk factors for liver fibrosis detected by transient elastography or shear wave elastography in inflammatory arthritis: a systematic review. Clin Exp Rheumatol 2017; 35: 1029-1036.
 
26.
Fitzpatrick R, Scott DG, Keary I. Cost-minimisation analysis of subcutaneous methotrexate versus biologic therapy for the treatment of patients with rheumatoid arthritis who have had an insufficient response or intolerance to oral methotrexate. Clin Rheumatol 2013; 32: 1605-1612.
 
27.
Rutkowska-Sak L, Rell-Bakalarska M, Lisowska B. Rola doustnej bądź podskórnej drogi podania małych dawek metotreksatu w redukcji objawów niepożądanych ze strony układu pokarmowego. Reumatologia 2009; 47: 207-211.
 
28.
Li D, Yang Z, Kang P, Xie X. Subcutaneous administration of methotrexate at high doses makes a better performance in the treatment of rheumatoid arthritis compared with oral administration of methotrexate: A systematic review and metaanalysis. Semin Arthritis Rheum 2016; 45: 656-662.
 
29.
Bianchi G, Caporali R, Todoerti M, Mattana P. Methotrexate and rheumatoid arthritis: current evidence regarding subcutaneous versus oral routes of administration. Adv Ther 2016; 33: 369-378.
 
30.
Wluka A, Buchbinder R, Mylvaganam A, et al. Long term methotrexate use in rheumatoid arthritis: 12 year follow up of 460 patients treated in community practice. J Rheumatol 2000; 27: 1864-1871.
 
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