Methotrexate in early rheumatoid arthritis: Is the anchor drug still holding?

被引：18

作者：

Giollo, Alessandro ^{[1
]}

Fuzzi, Enrico ^{[1
]}

Doria, Andrea ^{[1
]}

机构：

[1] Univ Padova Hosp Trust, Dept Med, Div Rheumatol, Via Nicolo Giustiniani 2, I-35128 Padua, Italy

来源：

AUTOIMMUNITY REVIEWS | 2022年 / 21卷 / 04期

关键词：

Rheumatoid; Arthritis; JAK; Early; Monotherapy; tsDMARDs; DOUBLE-BLIND; TREATMENT STRATEGY; TOFACITINIB MONOTHERAPY; CONTROLLED-TRIAL; HERPES-ZOSTER; ADHERENCE; COMBINATION; TOCILIZUMAB; SAFETY; RISK;

D O I：

10.1016/j.autrev.2022.103031

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Treat-to-target (T2T) is currently the most fashionable strategy for treatment-naive, early rheumatoid arthritis (RA) patients. A T2T approach can lead to a complete and drug-free disease remission, whereas failure to obtain remission leads to damage early in the disease course. Hence, one should try to achieve high remission rates as early as possible, implementing the best therapeutic strategies available. Methotrexate (MTX) combined with glucocorticoid bridging is the mainstay of T2T. However, MTX is often used suboptimally in RA patients for many reasons, including poor tolerability, low compliance, and safety issues. Recent evidence has suggested that novel targeted synthetic DMARDs (tsDMARDs) such as the Janus-kinase (JAK) inhibitors in combination with glucocorticoids yielded better outcomes in early RA than conventional treatment. Such an approach may have advantages in terms of patients' outcomes, though some concerns about serious adverse events need to be addressed.

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页数：7

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