Cyclosporin A monotherapy versus cyclosporin A and methotrexate combination therapy in patients with early rheumatoid arthritis: a double blind randomised placebo controlled trial

Gerards, A.; Landewé, Robert; Prins, A.; Bruijn, GA; Laan, R.F.J.M.; Dijkmans, Ben A. C.

doi:10.1136/ard.62.4.291

Cited by 87 publications

(39 citation statements)

References 28 publications

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“…Whereas Capell et al showed that SSP-MTX combination therapy provided significant beneficial clinical effects as compared with MTX monotherapy [22], others have reported that SSP provides no beneficial additive or synergistic effects in combination with MTX [23]. Also, although clinical trials of combination therapies with MTX plus other immunosuppressants or strong DMARDs, including cyclosporine A (CsA) or leflunomide, have shown beneficial effects in RA patients with high disease activity, there is an increased risk of adverse effects with these generally acting drugs [24,25]. By contrast, combination therapy with MZR and MTX was well tolerated, with no severe adverse effects on either the clinical symptoms or laboratory findings in the present clinical trial and the data from a largescale prospective cohort study [26].…”

Section: Discussionmentioning

confidence: 95%

Effects of low-dose mizoribine pulse therapy in combination with methotrexate in rheumatoid arthritis patients with an insufficient response to methotrexate

et al. 2009

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The aim was to determine the efficacy of low-dose intermittent pulse administration of mizoribine (MZR), a purine synthesis inhibitor, in combination with methotrexate (MTX) to control the symptoms of rheumatoid arthritis (RA) in patients with an insufficient clinical response to MTX alone. Twenty-seven patients with active RA, despite treatment with MTX, were enrolled and given MZR in combination with MTX and continued for 24 weeks. The primary endpoint was assessment of clinical improvements using the European League against Rheumatism (EULAR) criteria. Administering MZR to RA patients with an insufficient response to MTX produced significant improvements in the Disease Activity Score 28 (DAS28) after 8-24 weeks. In addition, after 24 weeks, 60.0% and 8.0% of patients had achieved moderate and good responses, respectively, and there were significant reductions in Modified Health Assessment Questionnaire and serum matrix metalloproteinase-3 levels. The present preliminary study suggests that low-dose MZR in combination with MTX is well tolerated and provides both clinical and economic benefits.

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Section: Discussionmentioning

confidence: 95%

Effects of low-dose mizoribine pulse therapy in combination with methotrexate in rheumatoid arthritis patients with an insufficient response to methotrexate

et al. 2009

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“…CsA inhibits the mRNA expressions of not only IL-2 and IL-4, but also TNF-α, in human activated T cells [9]. A number of clinical trials have produced evidence to support the use of CsA for IBD and rheumatoid arthritis in humans [8,25]. In dogs, TNF-α has been indicated to play an important role in the pathogenesis of IBD and immune-mediated polyarthritis [13,27].…”

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confidence: 99%

Cyclosporine A Inhibits the mRNA Expressions of IL-2, IL-4 and IFN-.GAMMA., but not TNF-.ALPHA., in Canine Mononuclear Cells

2007

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ABSTRACT. The effects of the calcineurin inhibitors cyclosporine A (CsA) and FK506 on the mRNA expressions of various cytokines were evaluated in dogs to determine whether the effects of CsA and FK506 in dogs were similar to those in humans. The mRNA expression levels of the cytokines IL-2, IL-4, IFN-γ and TNF-α were measured in PHA-stimulated canine PBMC using real-time RT-PCR after incubation with CsA or FK506 for 5 hr. Both reagents inhibited IL-2, IL-4 and IFN-γ mRNA expressions in a dose-dependent manner. However, CsA hardly inhibited the mRNA expression of TNF-α. These findings are important for assessing the indications of CsA treatment in dogs.

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“…The use of combinations of disease-modifying antirheumatic drugs (DMARDs), tumor necrosis factor antagonists, and tight disease control have led to less progression of joint damage and better physical function (2)(3)(4)(5)(6)(7)(8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Cost‐utility analysis of treatment strategies in patients with recent‐onset rheumatoid arthritis

Goekoop-Ruiterman

Allaart

Vries-Bouwstra

et al. 2009

Arthritis & Rheumatism

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Objective. To evaluate societal costs and quality-adjusted life years (QALYs) of treatment strategies for patients with recent-onset active rheumatoid arthritis (RA). Methods. Patients (n ‫؍‬ 508) were randomly allocated to 1 of 4 treatment strategy groups: sequential monotherapy, step-up combination therapy, initial combination therapy with prednisone, or initial combination therapy with infliximab. For 2 years, patients reported cost and utility measures. Results. Average QALYs (ideally 2.00) for groups 1-4 were 1.29, 1.31, 1.32, and 1.41, respectively, for the British EuroQol (P < 0.05 for group 4 versus groups 1-3); 1.41, 1.43, 1.44, and 1.52, respectively, for the Dutch EuroQol (P < 0.05 for group 4 versus groups 1-3); and 1.38, 1.38, 1.39, and 1.44, respectively, for the Short Form 6D (P < 0.05 for group 4 versus groups 1-3). The Time Trade-Off showed no significant differences. In the primary analysis, using the friction cost method to value productivity, the cost-utility ratio for group 4 against the next best alternative was estimated at €130,000 (95% confidence interval €27,000, €3,000,000) per QALY. Using the human capital method, the value of sustained productivity in group 4 largely compensated for the extra medication costs. Conclusion. Initial combination therapy with infliximab for patients with recent-onset active RA resulted in significantly better quality of life than other strategies. Using the friction cost method, costs to achieve this improvement are generally considered too high, and initial combination therapy with prednisone should be preferred. However, depending on the extent to which productivity is valued, infliximab costs could be largely compensated for by savings on productivity. Since patterns of infliximab use had not yet stabilized after 2 years, longer followup may change the economic conclusions.

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Cyclosporin A monotherapy versus cyclosporin A and methotrexate combination therapy in patients with early rheumatoid arthritis: a double blind randomised placebo controlled trial

Cited by 87 publications

References 28 publications

Effects of low-dose mizoribine pulse therapy in combination with methotrexate in rheumatoid arthritis patients with an insufficient response to methotrexate

Effects of low-dose mizoribine pulse therapy in combination with methotrexate in rheumatoid arthritis patients with an insufficient response to methotrexate

Cyclosporine A Inhibits the mRNA Expressions of IL-2, IL-4 and IFN-.GAMMA., but not TNF-.ALPHA., in Canine Mononuclear Cells

Cost‐utility analysis of treatment strategies in patients with recent‐onset rheumatoid arthritis

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