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首页> 外文期刊>Journal of the Association of Physicians of India >A New Strategy of Drug Treatment in Nsaid-Unresponsive Ankylosing Spondylitis: Combination of Pamidronate and Methylprednisolone Monthly Intravenous Infusions on The Background of A Combination of Disease Modifying Drugs Sulfasalazine and Methotrexate
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A New Strategy of Drug Treatment in Nsaid-Unresponsive Ankylosing Spondylitis: Combination of Pamidronate and Methylprednisolone Monthly Intravenous Infusions on The Background of A Combination of Disease Modifying Drugs Sulfasalazine and Methotrexate

机译：在上述无反应性强直性脊柱炎中药物治疗的新策略：帕米膦酸和甲基泼尼松龙每月静脉输注的组合，以疾病改良药物柳氮磺吡啶和甲氨蝶呤的组合为背景

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Objectives: To assess short term efficacy and tolerability of a therapeutic strategy in patients with ankylosing spondylitis (AS) unresponsive to nonsteroidal anti-inflammatory drugs (NSAIDs) or coxibs and unable to take anti-tumour necrosis factor-a (anti-TNFa) biological treatment. Methods: Established AS patients were given a background treatment consisting of subcutaneous injections of methotrexate weekly (MTX, dose stepped up to a maximum of 20 to 25 mg), weekly 12-16 mg of methylprednisolone orally 30 mts before methotrexate dose (for nausea prevention), sulfasalazine (SSZ, 1 gm orally twice per day) with folic acid supplementation (5 mg daily except on the day of MTX). Additionally, they were given monthly cycles of intravenous (IV) methylprednisolone ?pulseê (MPP) and pamidronate infusions (MPP 500 mg 3 consecutive days + pamidronate 60 mg in a slow IV infusion on day 2 of the MPP infusion). A minimum of six treatment cycles at monthly intervals were given. Adjunct treatment consisted of 1 gm elemental calcium supplementation, paracetamol 650 mg ?as-and-when-requiredê for symptomatic pain relief, amitriptyline 10 mg 2 hours before bed time daily. Results: Of a total of 46 intent-to-treat patients, 39 patients achieved ASAS-20 and BASDAI-50 response (85%, 95% CI, range 71% to 94%); 7 (15 %) patients failed to improve. The expense involved in 6 months of treatment was approximately 10-fold less than anti-TNFa treatment over the same period of time. Conclusion: For AS patients unresponsive to standard NSAIDs/coxibs and unable to take anti-TNF biological agents a combination therapeutic strategy showed efficacy and good tolerability in a majority of patients evaluated over a short-term.
机译：目的：评估对非甾体抗炎药（NSAIDs）或考昔布无反应且无法服用抗肿瘤坏死因子-a（anti-TNFa）的强直性脊柱炎（AS）患者的短期治疗效果和治疗策略的耐受性治疗。方法：对已确诊的AS患者进行背景治疗，包括每周皮下注射甲氨蝶呤（MTX，剂量逐步增加至最大20至25 mg），甲氨蝶呤给药前30 mTS每周口服12-16 mg甲基泼尼松龙（用于预防恶心） ），柳氮磺吡啶（SSZ，每天1 gm口服两次，每天补充2次叶酸）（每天5 mg，MTX除外）。此外，他们每月接受一次静脉（IV）甲基强的松龙脉动（MPP）和帕米膦酸输注周期（MPP连续3天500 mg +帕米膦酸60 mg，在MPP输注的第2天缓慢静脉输注）。每月至少间隔六个治疗周期。辅助治疗包括补充1 gm的钙元素，对乙酰氨基酚650 mg（按需服用）以缓解症状性疼痛，阿米替林10 mg（每天睡前2小时）。结果：在总共46名意向治疗患者中，有39位患者获得了ASAS-20和BASDAI-50反应（85％，95％CI，范围从71％至94％）; 7名（15％）患者无法改善。在同一时间段内，治疗6个月的费用大约比抗TNFa治疗的费用低10倍。结论：对于对标准NSAID / coxib无反应且无法服用抗TNF生物制剂的AS患者，联合治疗策略在大多数短期评估的患者中均显示出疗效和良好的耐受性。

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