Dose Escalation of Methotrexate in Rheumatoid Arthritis Patients

摘要

Objective : To evaluate the efficacy and safety of dose escalation of methotrexate (MTX) in rheumatoid arthritis (RA) patients with inadequate response to MTX combination therapy. Methods : We retrospectively evaluated disease activities after MTX dose escalation in 48 patients. Results : The mean MTX dose was 10.8 ± 1.5 mg/week and the observation period was 7.2 ±2.9 months after dose escalation. After MTX dose escalation, the Disease Activity Score in 28 joint (DAS28) -ESR (3.9 ±1.1 to 3.3 ±1.3) and simplified disease activity index (SDAI : 15.0 ±7.4 to 11.6 ±9.8) were decreased significantly. Significant improvements of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), matrix metalloproteinase-3 (MMP-3) and swollen joint counts (SJC) were observed. Of the 37 patients with inadequate response to MTX, 10 were good- and 11 were judged as moderate responders after MTX dose escalation. Of the 5 patients with inadequate response to biologics, 2 were classified as moderate-responders. In total, 50.0% (24/48) were classified as good or moderate responders. There were no serious adverse events. Conclusions : MTX dose escalation was effective in both patients with inadequate response to DMARDs or biologies and in patients who lost response to biologies.