Rheumatology

doi: 10.25005/2074-0581-2019-21-3-426-431
COMPARATIVE ANALYSIS AND EVALUATION OF THE EFFECTIVENESS OF METHOTREXATE AND LEFLUNOMIDE IN PATIENTS WITH ACTIVE RHEUMATOID ARTHRITIS IN THE CONDITIONS OF CAREFUL CONTROL BASED ON PRINCIPLES OF «TREAT TO TARGET» STRATEGY

S.B. Bekmurodzoda, K.O. Sharifov, M.M. Madzhonova, Yo.U. Saidov, Kh.R. Makhmudov

Department of Propedeutics of Internal Medicine, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan

Objective: To study and evaluate in a comparative aspect the effectiveness of methotrexate (MT) and leflunomide (LEF) in patients with active rheumatoid arthritis (RA) who have indicators of adverse «Treat to target – T2T» strategy.

Methods: Monitoring and comparative evaluation of the effectiveness of therapy of modern basic anti-inflammatory drugs in 104 patients with active RA, which, depending on the character of the therapy was randomized and divided into three groups: I (n=34) – Metoject group (MTJ), II (n=36) – MT group and III (n=34) – LEF group.

Results: Against the background of the therapy of MTJ, MT and LEF, the patients surveyed showed a statistically significant decrease in both clinicallaboratory activity indicators of RA and the level of pro-inflammatory cytokines (tumor necrosis factor alpha – TNFα, interleukin-6 – IL-6), the positive results of which were most vividly represented in patients of the MTJ group. By the time the study is completed (after 12 months), most patients have achieved the ultimate goal of therapy – a state of low disease activity/remission – and this figure, for I, II and III groups consisted of 78.2%, 73.1% and 44% respectively.

Conclusion: The results of the study show a satisfactory performance/tolerability profile of MTJ, MT and LEF in an intensive mode in conditions of close scrutiny based on T2T strategy.

Keywords: Rheumatoid arthritis, metoject, methotrexate, leflunomide, treatment , T2T strategy.

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References
  1. Nasonov EL. Problemy immunopatologii revmatoidnogo artrita: evolyutsiya bolezni [Problems of rheumatoid arthritis immunopathology: evolution of the disease]. Nauchno-prakticheskaya revmatologiya. 2017;55(3):277-94. Available from: https://doi.org/10.14412/1995-4484-2017-277-294.
  2. Catrina AI, Svensson CI, Malmström V, Schett G, Klareskog L. Mechanisms leading from systemic autoimmunity to joint-specific disease in rheumatoid arthritis. Nat Rev Rheumatol. 2017;13(2):79-86. Available from: https://doi. org/10.1038/nrrheum.2016.200.
  3. Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. Lancet. 2016;388(10055):2023-38. Available from: https://doi.org/10.1016/S0140- 6736(16)30173-8.
  4. Chichasova NV. Otsenka effektivnosti i perenosimosti Leflunomida (Elafra) u bol’nykh revmatoidnym artritom po dannym otkrytogo mnogotsentrovogo issledovaniya [Evaluation of the efficacy and tolerability of leflunomide (Elafra) in patients with rheumatoid arthritis according to the data of an open-label multicenter study]. Nauchno-prakticheskaya revmatologiya. 2018;56(4):466-73. Available from: https://doi.org/10.14412/1995-4484- 2018-466-473.
  5. Karateev DE. Ostrye voprosy strategii lecheniya revmatoidnogo artrita [Treatment strategy for rheumatoid arthritis: hot topics]. Sovremennaya revmatologiya. 2015; 9(1): 84-92. Available from: https://doi.org/10.14412/1996- 7012-2015-1-84-92.
  6. Karateev DE, Luchikhina EL. Sovremennye principy vedenie bol’nyh s revmatoidnym artritom [Modern principles of management of patients with rheumatoid arthritis]. Meditsinskiy sovet. 2017;17:92-100. Available from: https://doi.org/10.21518/2079-701X-2017-17-92-100.
  7. Wabe N, Sorich MJ, Wechalekar MD, Cleland LG, McWilliams L, Lee A, et al. Characterising deviation from treat-to-target strategies for early rheumatoid arthritis: the first three years. Arthritis Res Ther. 2015;17:48. Available from: https://doi.org/10.1186/s13075-015-0562-0.
  8. Solomon DH, Bitton A, Katz JN, Radner H, Brown EM, Fraenkel L. Review: treat to target in rheumatoid arthritis: fact, fiction, or hypothesis? Arthritis Rheumatol. 2014;66(4):775-82. Available from: https://doi.org/10.1002/ art.38323.
  9. Karateev DE, Luchikhina EL, Demidova NV, Gridneva GI, Lukina GV, Kanonirova MA, i dr. Primenenie podkozhnoy formy metotreksata dlya lecheniya bol’nykh aktivnym revmatoidnym artritom (issledovanie REMARKA) [Use of subcutaneous methotrexate for the treatment of patients with active rheumatoid arthritis: the REMARCA trial]. Nauchno-prakticheskaya revmatologiya. 2016;54(2):138-44. Available from: https://doi.org/10.14412/1995- 4484-2016-138-144.
  10. Makhmudov KhR, Saidov YoU. Strategiya «Lechenie do dostizheniya tseli» v terapii revmatoidnogo artrita [Strategy “Treat to target” in the therapy of rheumatoid arthritis]. Vestnik Avitsenny [Avicenna Bulletin]. 2015;4:126-32.
  11. Avdeeva AS, Novikov AA, Aleksandrova EN, Karateev DE, Luchikhina EL, Nasonov EL. Dinamika urovney tsitokinov na fone terapii metotreksatom i adalimumabom u patsientov s rannim revmatoidnym artritom (issledovanie REMARKA) [Changes of cytokine levels during therapy with methotrexate and adalimumab in patients with early rheumatoid arthritis (REMARKA study)]. Nauchno-prakticheskaya revmatologiya. 2014;52(3):254-62. Available from: https://doi.org/10.14412/1995-4484-2014-254-62.
  12. Udachkina EV, Novikova DS, Popkova TV, Kirillova IG, Gorbunova YuN, Markelova EI, i dr. Dinamika lipidnykh parametrov krovi u bol’nykh rannim revmatoidnym artritom na fone protivorevmaticheskoy terapii, provodimoy po printsipu «Lechenie do dostizheniya tseli» (po dannym 18-mesyachnogo nablyudeniya) [Time course of changes in blood lipid parameters in patients with early rheumatoid arthritis during treat-to-target antirheumatic therapy: according to 18-month follow-up findings]. Nauchno-prakticheskaya revmatologiya. 2016;54(2):164-70. Available from: https://doi.org/10.14412/1995- 4484-2016-164-170.
  13. Nasonov EL. Rekomendatsii EULAR po diagnostike i lecheniyu rannego artrita: 2016 [The 2016 EULAR guidelines for the diagnosis and treatment of early arthritis]. Nauchno-prakticheskaya revmatologiya. 2017;55(2):138-50. Available from: https://doi.org/10.14412/1995-4484-2017-138-150.
  14. Olyunin YuA. Otsenka aktivnosti zabolevaniya pri revmatoidnom artrite: rekomendatsii i praktika [Assessment of disease activity in rheumatoid arthritis: recommendations and practice]. Sovremennaya revmatologiya. 2014;8(2):4-9.
  15. Futó G, Somogyi A, Szekanecz Z. Visualization of DAS28, SDAI, and CDAI: the magic carpets of rheumatoid arthritis. Clin Rheumatol. 2014;33(5):623-9. Available from: https://doi.org/10.1007/s10067-014-2559-5.
  16. Fedorenko EV, Lukina GV, Sigidin YaA, Luchikhina EL, Karateev DE. Sravnitel’naya effektivnost’ i perenosimost’ sovremennykh metodov terapii rannego revmatoidnogo artrita [Comparative efficiency and tolerability of current therapies for early rheumatoid arthritis]. Nauchno-prakticheskaya revmatologiya. 2015;53(2):162-8. Available from: https://doi.org/10.14412/1995- 4484-2015-162-168
  17. Nasonov EL. Metotreksat pri revmatoidnom artrite – 2015: novye fakty i idei [Methotrexate in rheumatoid arthritis – 2015: New facts and ideas]. Nauchno-prakticheskaya revmatologiya. 2015;53(4):421-33. Available from: https://doi.org/10.14412/1995-4484-2015-421-433.
  18. Makhmudov KhR, Saidov YoU, Zubaydov RN. Otsenka effektivnosti primeneniya Metotreksata u bol’nykh s revmatoidnym artritom v svete implementatsii strategii “treat to target” v real’noy klinicheskoy praktike [Evaluation of methotrexate use for patients with rheumatoid arthritis during implementation of “Treat to Target” strategy in real clinical practice]. Vestnik Avitsenny [Avicenna Bulletin]. 2015;3:77-82.

Authors' information:


Bekmurodzoda Sulton Begmurod
Applicant of the Department of Propedeutics of Internal Diseases, Avicenna Tajik State Medical University
Author ID: 1041134
SPIN: 9530-8549
E-mail: bekmurods@mail.ru

Sharifov Kuvvatali Orifovich
Assistant of the Department of Propedeutics of Internal Diseases, Avicenna Tajik State Medical University

Madzhonova Makhvash Mirzoalievna
Applicant of the Department of Propedeutics of Internal Diseases, Avicenna Tajik State Medical University

Saidov Yor Umarovich
Doctor of Medical Sciences, Head of the Department of Propedeutics of Internal Diseases, Avicenna Tajik State Medical University
Author ID: 844625
SPIN: 1842-1931
E-mail: erumarovich@mail.ru

Makhmudov Khayom Ruziboevich
Candidate of Medical Sciences, Assistant of the Department of Propedeutics of Internal Diseases, Avicenna Tajik State Medical University
Author ID: 720314
SPIN: 1025-4700
E-mail: mahmudovkh@yandex.ru

Information about support in the form of grants, equipment, medications

The authors did not receive financial support from manufacturers of medicines and medical equipment.

Conflicts of interest: No conflict

Address for correspondence:


Saidov Yor Umarovich
Doctor of Medical Sciences, Head of the Department of Propedeutics of Internal Diseases, Avicenna Tajik State Medical University

734003, Republic of Tajikistan, Dushanbe, Rudaki Ave., 139

Tel.: +992 (918) 694819

E-mail: erumarovich@mail.ru

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