来氟米特和甲氨蝶呤联合用药治疗类风湿关节炎的疗效

Effects of leflunomide combined with methotrexate in treatment of rheumatoid arthritis

目的:比较来氟米特(LEF)和甲氨蝶呤(MTX)联合用药与来氟米特、甲氨蝶呤单独用药的疗效和不良反应。方法:将96例活动性类风湿关节炎病人分为3组。联合用药组32例,口服LEF 10mg,每日1次,MTX 7.5mg,每周1次;LEF组32例,口服LEF 20mg,每日1次;用药前3d,两组均给予负荷剂量LEF 50mg/d;MTX组给予口服MTX 10mg,每周1次。观察评价休息痛、晨僵、握力、关节压痛指数、关节肿胀指数、生活能力、病人评价、医生评价、血沉、C-反应蛋白、类风湿因子等指标。结果:用药24周3组的主要疗效指标的改善差异无显著性,P>0.05。联合用药组和LEF组、MTX组的有效率分别为93.8%、90.6%、87.5%,不良反应发生率分别为31.3%、28.1%、43.8%。结论:联合用药疗效与单用来氟米特、甲氨蝶呤相近,但联合用药的不良反应稍高于单用来氟米特。

Objective： To compare the efficary and adverse reaction of leflunomide （LEF） plus methotrexate（MTX） （ Group LEF ＋ MTX） and LEF alone （Group LEF）,MTX alone（Group MTX） in the treatment of active rheumatoid arthritis （RA）. Methods：96 cases were divided into three groups. 32 partients of the combination group administrated LEF 10mg, po, qd and MTX 7.5mg po, qw; 32 partients of LEF group recerived LEF 20mg,po,qd;32 patients of MTX group received MTX 10mg po, qw.At the first 3d,the dose Of LEF for all patients was 50mg/d. The indexes of the efficiency assessment included restpain, moring stiffness, gripping strength, count of joint tenderness（TJC）, count of joint swollen （SJC）, activities of daily living , ESR, C- reactive protein（CRP）, RF. Results： No significant differences were found in efficiency assessment indexes between the three groups after 24 weeks treatment. The efficacy rate of group LEF ＋ MTX was 93.8 %, 90.6 % for group LEF,87.5% for group MTX. The rate of adverse reaction was 31.3% in combination group and 28.1% in LEF greup,43.8% in MTX group. Conclusions：The efficacy of LEF combined with MTX in the treament of rheumatoid arthritis is similar between group LEF and group MTX alone. The rate of adverse reaction is a little higher in LEF and MTX combined therapy than in LEF alone.