Efficacy and safety of a combination therapy of methotrexate, chloroquine and cyclophosphamide in patients with refractory rheumatoid arthritis: Results of an observational study with matched-pair analysis
G. Keyszer et al., Efficacy and safety of a combination therapy of methotrexate, chloroquine and cyclophosphamide in patients with refractory rheumatoid arthritis: Results of an observational study with matched-pair analysis, CLIN RHEUMA, 18(2), 1999, pp. 145-151
The efficacy and safety of a combination of methotrexate (MTX), chloroquine
(CQ) and cyclophosphamide (CYC) were studied in patients with refractory r
heumatoid arthritis. A single-centre, matched-pair observational study with
prospectively gathered data was performed. Fifty-six patients who had prev
iously failed with MTX were treated with 15 mg MTX per week, 50 mg CYC thre
e times a week and 250 mg CQ per day (group A). A 50% improvement of the sw
ollen joint count was required to continue therapy. Data were compared with
the results of the previous MTX therapy in the same group and with a match
ed-patient cohort receiving MTX monotherapy for the first time (group B). I
n group A, the combination therapy resulted in a significant decline of the
swollen joint count after 1 year, in contrast to the previous MTX monother
apy in the same group. Complete remission of joint swelling was achieved in
13 patients (23%), compared with 26 patients in group B (47%). The median
duration of effective combination treatment in group A was significantly lo
nger than preceding therapies with MTX alone (19 vs 13 months, p<0.05). How
ever, patients in group B could be treated for a median of 57.5 months (p<0
.0001 compared with group A). Side-effects were comparable in both groups.
The applied DMARD combination is safe and beneficial in a significant propo
rtion of patients if MTX monotherapy is ineffective.