寛解中の若年性イディオパシー関節炎における6ヶ月対12ヶ月のメソトレキサート離脱:ランダム化臨床試験
Dirk Foell1, Nico Wulffraat, Lucy R Wedderburn
1Department of Pediatrics, University of Muenster, Albert-Schweitzer-Strasse 33, D-48149 Muenster, Germany. dfoell@uni-muenster.de
JAMA
|April 8, 2010
まとめ
青少年のイディオパシー性関節炎 (JIA) のメトトレキサート治療の延長は,再発率を下げなかった. しかし,骨髄膜関連タンパク質8および14 (MRP8/14) のレベルが上昇すると,薬の投与を中止した後の発作のリスクが高くなります.
科学分野:
- レウマトロジーの病理学
- 小児免疫学 小児免疫学
- クリニック・トライアル研究
背景:
- 新種の治療法により,青少年のイディオパシー性関節炎 (JIA) の寛解率が改善されています.
- テーパリング療法とサブクリニカル炎症の特定は,JIAの管理における重要な課題です.
- 薬物中断後の再発リスクを予測するために,バイオマーカーが必要です.
研究 の 目的:
- 寛解中のJIA患者のメトトレキサート治療の延長が,離脱後の再発率を低下させるかどうかを判断する.
- ミエロイド関連タンパク質8と14 (MRP8/14) がJIA患者の発作を予測できるかどうかを調査する.
主な方法:
- 61のセンターで364人のJIA患者を対象とした前向きなランダム化臨床試験.
- 患者は寛解を達成した後,6か12ヶ月間メトトレキサートを受けた.
- ミエロイド関連タンパク質8および14 (MRP8/14) レベルは,治療中止時に測定されました.
主要な成果:
- 6ヶ月と12ヶ月間のメトトレキサート群 (56.7%対55.6%) の間での再発率の有意な違いはありません.
- より高いMRP8/14レベルは,その後のフレアと有意に関連していた (P = .003).
- 低MRP8/14レベルは,3ヶ月以内に発火のリスクが低いことを予測しました (AUC = 0.76).
結論:
- 12ヶ月のメトトレキサート離脱戦略は,6ヶ月と比較してJIA患者の再発率を低下させませんでした.
- MRP8/14濃度の上昇は,メトトレキサート投与を中止した後に再発のリスクの増加と関連しています.
- MRP8/14は,JIAでのフレアの予測のための潜在的なバイオマーカーとして機能します.
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