Effectiveness of triple therapy using tacrolimus, mizoribine and methotrexate (MTX) for rheumatoid arthritis patients refractory to MTX ～ comparison to biologic agents ～

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  • Torikai Eiji
    Department of Orthopedic Surgery, Hamamatsu University School of Medicine
  • Suzuki Motohiro
    Department of Orthopedic Surgery, Hamamatsu University School of Medicine
  • Matsuyama Yukihiro
    Department of Orthopedic Surgery, Hamamatsu University School of Medicine

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  • メトトレキサート効果不十分症例に対するタクロリムス，ミゾリビンを追加した３剤併用療法の効果　～生物学的製剤併用療法との比較～

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<p>[Objective] We have retrospectively compared a triple therapy consisting of a combination of disease-modifying anti-rheumatic drugs with biologic agents for patients with established rheumatoid arthritis (RA) who had not improved despite treatment with methotrexate (MTX).<br> [Materials and Methods] We classified patients in 2 groups, one group added Tacrolimus (TAC) and Mizoribine (MZR) (S group) and the other added TNF inhibitor (B group). DAS28CRP, modified total sharp score and ARASHI change score which is scoring system of large joint destruction were evaluated and compared between both groups. We also estimated and compared the survival rate and the reasons of discontinuation of each group.<br> [Results] There was no significant difference in baseline characteristics between two groups. Both groups showed significant improvement of disease activity. The improvement rate of DAS28CRP in the B group was higher than that in the S group at 1 month after the treatment. However, no significant difference was observed between　two groups at 3 months after treatment and it continued during 2 years. There was no significant difference in radiographic progression of large joints. However the progression of small joint damage was more severe than that in S group. Sixteen percent in S group and 4.3% in B group had discontinued because of adverse events.<br> [Conclusion] Triple therapy using TAC, MZR and MTX had advantage in medical exponses compared with biologics for established RA patients. However the triple therapy might be inferior to biologics in inhibiting small joint destruction and safety, we should be careful about them.</p>

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