Analýza příčin přerušení terapie DMARDsu pacientů s revmatoidní artritidou

Analysis of Reasons for Discontinuation of DMARDs in Patients with Rheumatoid Arthritis

The authors performed an epidemiological study which evaluated treatment of rheumatoid arthritisby different disease modifying drugs (DMARDs) from the aspect of effectiveness and toxicity. It wasa retrospective multicentre trial where the documentation of 15 rheumatological out- an in-patientdepartments in the Czech and Slovak Republic was used. Based on this documentation the physiciancompleted a questionnaire which was processed by computer. A total of 1162 cases of discontinuedDMARDs therapy in 760 patients with RA was recorded. Discontinuation of therapy on account ofside effects was recorded most frequently in gold therapy and in treatment with methotrexate (inboth some 60% of documented cases discontinued treatment). The least frequent discontinuationfor side effects was found with antimalarial drugs (less than 25 %). On the other hand, due to theinsufficient effectiveness, the antimalarials were discontinued most frequently (66 %), whereascyclophosphamide discontinuation was observed in the least number of cases (less than 20 %). Themean period of DMARDs therapy was almost 30 months. It is surprising that cyclophosphamide wasadministered for the longest period (mean 39 months). Cyclosporin was administered for the shortestperiod (mean 9 months). The period of treatment correlated significantly with the patient’s age atthe time when treatment was started, with the positivity of the rheumatoid factor, extraarticularsymptoms and the patient’s education. Conversely no relationship was found between the period ofDMARDs administration and other factors such as sex, sedimentation rate, concurrent corticoidadministration.

Key words:
rheumatoid arthritis, treatment, disease modifying drugs, DMARDs, side effects,inadequate effectiveness