Safety and retention of combination triple disease‐modifying anti‐rheumatic drugs in new‐onset rheumatoid arthritis
Identifieur interne : 000692 ( Istex/Curation ); précédent : 000691; suivant : 000693Safety and retention of combination triple disease‐modifying anti‐rheumatic drugs in new‐onset rheumatoid arthritis
Auteurs : L. Cummins [Australie] ; V. S. Katikireddi [Australie] ; S. Shankaranarayana [Australie] ; K. Y. C. Su [Australie] ; E. Duggan [Australie] ; V. Videm [Australie, Norvège] ; H. Pahau [Australie] ; R. Thomas [Australie]Source :
- Internal Medicine Journal [ 1444-0903 ] ; 2015-12.
Abstract
Background: While efficacy of combination treatment with methotrexate (MTX), sulfasalazine (SSZ) and hydroxychloroquine (HCQ) (‘triple therapy’) has been shown in clinical trials, few studies have examined its longevity in a real‐life setting. Aim: Our aim was to assess the tolerability, longevity and efficacy of a triple disease‐modifying anti‐rheumatic drug (DMARD) regimen initiated in new‐onset rheumatoid arthritis (RA) patients. Methods: Patients who met 1987 American College of Rheumatology criteria for RA with disease duration less than 2 years were offered triple therapy upon diagnosis. Treatment was intensified according to a response‐driven step‐up algorithm, which included progression to leflunomide (LEF) or a biologic agent. Results: Of 181 new‐onset RA patients, 119 commenced triple therapy. Median duration of triple therapy was 39 weeks, and 23.5% remained on it at last follow up, with median follow up 104 weeks. Continuous therapy with any three‐DMARD combination (including LEF) occurred in 32% at last follow up, with median duration of 70 weeks. Cessation of at least one of MTX, SSZ or HCQ occurred because of an adverse event in 38%, remission in 7% and incomplete response in 28% of patients. SSZ accounted for 49% of initial drug withdrawals for an adverse event. Continuation of three‐drug therapy did not significantly influence the proportion of patients achieving remission or low disease activity (LDA). Conclusions: Triple therapy in new‐onset RA was reasonably well tolerated, persisting for median 39 weeks. SSZ intolerance commonly reduces longevity of triple therapy. Treating to the target of remission or LDA is more important than the number of DMARD continued.
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DOI: 10.1111/imj.12896
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Cummins</name><affiliation wicri:level="1"><mods:affiliation>University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Queensland, Australia</mods:affiliation><country xml:lang="fr">Australie</country><wicri:regionArea>University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Queensland</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>Princess Alexandra Hospital, Queensland, Brisbane, Australia</mods:affiliation><country xml:lang="fr">Australie</country><wicri:regionArea>Princess Alexandra Hospital, Queensland, Brisbane</wicri:regionArea></affiliation></author><author><name sortKey="Katikireddi, V S" sort="Katikireddi, V S" uniqKey="Katikireddi V" first="V. S." last="Katikireddi">V. S. Katikireddi</name><affiliation wicri:level="1"><mods:affiliation>University of Queensland Diamantina Institute, Translational Research Institute, Queensland, Brisbane, Australia</mods:affiliation><country xml:lang="fr">Australie</country><wicri:regionArea>University of Queensland Diamantina Institute, Translational Research Institute, Queensland, Brisbane</wicri:regionArea></affiliation></author><author><name sortKey="Shankaranarayana, S" sort="Shankaranarayana, S" uniqKey="Shankaranarayana S" first="S." last="Shankaranarayana">S. 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Pahau</name><affiliation wicri:level="1"><mods:affiliation>University of Queensland Diamantina Institute, Translational Research Institute, Queensland, Brisbane, Australia</mods:affiliation><country xml:lang="fr">Australie</country><wicri:regionArea>University of Queensland Diamantina Institute, Translational Research Institute, Queensland, Brisbane</wicri:regionArea></affiliation></author><author><name sortKey="Thomas, R" sort="Thomas, R" uniqKey="Thomas R" first="R." last="Thomas">R. Thomas</name><affiliation wicri:level="1"><mods:affiliation>University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Queensland, Australia</mods:affiliation><country xml:lang="fr">Australie</country><wicri:regionArea>University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Queensland</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>Princess Alexandra Hospital, Queensland, Brisbane, Australia</mods:affiliation><country xml:lang="fr">Australie</country><wicri:regionArea>Princess Alexandra Hospital, Queensland, Brisbane</wicri:regionArea></affiliation><affiliation><mods:affiliation>CorrespondenceRanjeny Thomas, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Qld 4102, Australia.Email:</mods:affiliation><wicri:noCountry code="subField">Australia.Email:</wicri:noCountry></affiliation><affiliation wicri:level="1"><mods:affiliation>E-mail: ranjeny.thomas@uq.edu.au</mods:affiliation><country wicri:rule="url">Australie</country></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:29DBE3741864C51565F2C98CC77215329978D3AE</idno><date when="2015" year="2015">2015</date><idno type="doi">10.1111/imj.12896</idno><idno type="url">https://api.istex.fr/ark:/67375/WNG-BL4FV68G-Q/fulltext.pdf</idno><idno type="wicri:Area/Istex/Corpus">000692</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">000692</idno><idno type="wicri:Area/Istex/Curation">000692</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main">Safety and retention of combination triple disease‐modifying anti‐rheumatic drugs in new‐onset rheumatoid arthritis</title><author><name sortKey="Cummins, L" sort="Cummins, L" uniqKey="Cummins L" first="L." last="Cummins">L. Cummins</name><affiliation wicri:level="1"><mods:affiliation>University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Queensland, Australia</mods:affiliation><country xml:lang="fr">Australie</country><wicri:regionArea>University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Queensland</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>Princess Alexandra Hospital, Queensland, Brisbane, Australia</mods:affiliation><country xml:lang="fr">Australie</country><wicri:regionArea>Princess Alexandra Hospital, Queensland, Brisbane</wicri:regionArea></affiliation></author><author><name sortKey="Katikireddi, V S" sort="Katikireddi, V S" uniqKey="Katikireddi V" first="V. S." last="Katikireddi">V. S. Katikireddi</name><affiliation wicri:level="1"><mods:affiliation>University of Queensland Diamantina Institute, Translational Research Institute, Queensland, Brisbane, Australia</mods:affiliation><country xml:lang="fr">Australie</country><wicri:regionArea>University of Queensland Diamantina Institute, Translational Research Institute, Queensland, Brisbane</wicri:regionArea></affiliation></author><author><name sortKey="Shankaranarayana, S" sort="Shankaranarayana, S" uniqKey="Shankaranarayana S" first="S." last="Shankaranarayana">S. Shankaranarayana</name><affiliation wicri:level="1"><mods:affiliation>University of Queensland Diamantina Institute, Translational Research Institute, Queensland, Brisbane, Australia</mods:affiliation><country xml:lang="fr">Australie</country><wicri:regionArea>University of Queensland Diamantina Institute, Translational Research Institute, Queensland, Brisbane</wicri:regionArea></affiliation></author><author><name sortKey="Su, K Y C" sort="Su, K Y C" uniqKey="Su K" first="K. Y. C." last="Su">K. Y. C. Su</name><affiliation wicri:level="1"><mods:affiliation>University of Queensland Diamantina Institute, Translational Research Institute, Queensland, Brisbane, Australia</mods:affiliation><country xml:lang="fr">Australie</country><wicri:regionArea>University of Queensland Diamantina Institute, Translational Research Institute, Queensland, Brisbane</wicri:regionArea></affiliation></author><author><name sortKey="Duggan, E" sort="Duggan, E" uniqKey="Duggan E" first="E." last="Duggan">E. Duggan</name><affiliation wicri:level="1"><mods:affiliation>University of Queensland Diamantina Institute, Translational Research Institute, Queensland, Brisbane, Australia</mods:affiliation><country xml:lang="fr">Australie</country><wicri:regionArea>University of Queensland Diamantina Institute, Translational Research Institute, Queensland, Brisbane</wicri:regionArea></affiliation></author><author><name sortKey="Videm, V" sort="Videm, V" uniqKey="Videm V" first="V." last="Videm">V. Videm</name><affiliation wicri:level="1"><mods:affiliation>University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Queensland, Australia</mods:affiliation><country xml:lang="fr">Australie</country><wicri:regionArea>University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Queensland</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway</mods:affiliation><country xml:lang="fr">Norvège</country><wicri:regionArea>Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>Department of Immunology and Transfusion Medicine, St Olav University Hospital, Trondheim, Norway</mods:affiliation><country xml:lang="fr">Norvège</country><wicri:regionArea>Department of Immunology and Transfusion Medicine, St Olav University Hospital, Trondheim</wicri:regionArea></affiliation></author><author><name sortKey="Pahau, H" sort="Pahau, H" uniqKey="Pahau H" first="H." last="Pahau">H. Pahau</name><affiliation wicri:level="1"><mods:affiliation>University of Queensland Diamantina Institute, Translational Research Institute, Queensland, Brisbane, Australia</mods:affiliation><country xml:lang="fr">Australie</country><wicri:regionArea>University of Queensland Diamantina Institute, Translational Research Institute, Queensland, Brisbane</wicri:regionArea></affiliation></author><author><name sortKey="Thomas, R" sort="Thomas, R" uniqKey="Thomas R" first="R." last="Thomas">R. Thomas</name><affiliation wicri:level="1"><mods:affiliation>University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Queensland, Australia</mods:affiliation><country xml:lang="fr">Australie</country><wicri:regionArea>University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Queensland</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>Princess Alexandra Hospital, Queensland, Brisbane, Australia</mods:affiliation><country xml:lang="fr">Australie</country><wicri:regionArea>Princess Alexandra Hospital, Queensland, Brisbane</wicri:regionArea></affiliation><affiliation><mods:affiliation>CorrespondenceRanjeny Thomas, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Qld 4102, Australia.Email:</mods:affiliation></affiliation><affiliation wicri:level="1"><mods:affiliation>E-mail: ranjeny.thomas@uq.edu.au</mods:affiliation><country wicri:rule="url">Australie</country></affiliation></author></analytic><monogr></monogr><series><title level="j" type="main">Internal Medicine Journal</title><title level="j" type="alt">INTERNAL MEDICINE JOURNAL</title><idno type="ISSN">1444-0903</idno><idno type="eISSN">1445-5994</idno><imprint><biblScope unit="vol">45</biblScope><biblScope unit="issue">12</biblScope><biblScope unit="page" from="1266">1266</biblScope><biblScope unit="page" to="1273">1273</biblScope><biblScope unit="page-count">9</biblScope><date type="published" when="2015-12">2015-12</date></imprint><idno type="ISSN">1444-0903</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">1444-0903</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract">Background: While efficacy of combination treatment with methotrexate (MTX), sulfasalazine (SSZ) and hydroxychloroquine (HCQ) (‘triple therapy’) has been shown in clinical trials, few studies have examined its longevity in a real‐life setting. Aim: Our aim was to assess the tolerability, longevity and efficacy of a triple disease‐modifying anti‐rheumatic drug (DMARD) regimen initiated in new‐onset rheumatoid arthritis (RA) patients. Methods: Patients who met 1987 American College of Rheumatology criteria for RA with disease duration less than 2 years were offered triple therapy upon diagnosis. Treatment was intensified according to a response‐driven step‐up algorithm, which included progression to leflunomide (LEF) or a biologic agent. Results: Of 181 new‐onset RA patients, 119 commenced triple therapy. Median duration of triple therapy was 39 weeks, and 23.5% remained on it at last follow up, with median follow up 104 weeks. Continuous therapy with any three‐DMARD combination (including LEF) occurred in 32% at last follow up, with median duration of 70 weeks. Cessation of at least one of MTX, SSZ or HCQ occurred because of an adverse event in 38%, remission in 7% and incomplete response in 28% of patients. SSZ accounted for 49% of initial drug withdrawals for an adverse event. Continuation of three‐drug therapy did not significantly influence the proportion of patients achieving remission or low disease activity (LDA). Conclusions: Triple therapy in new‐onset RA was reasonably well tolerated, persisting for median 39 weeks. SSZ intolerance commonly reduces longevity of triple therapy. Treating to the target of remission or LDA is more important than the number of DMARD continued.</div></front></TEI></record>Pour manipuler ce document sous Unix (Dilib)
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