Methotrexate, Leflunomide, Cyclophosphamide Comparison Between Two Combined Effecs

【Background】rheumatoid arthritis is a highly disabling disease.70% of RA patients with erosive joint changes. About 90% occurred 2 years before the disease. about 14% of the 12 months or less at the onset to stop working, and 36% in 41 months when the disease to stop working. RA has a prevalence rate, high morbidity, mortality rate characteristics.50-70% RA patients onset occurred within 2 years imaging visible bone destruction. [1] In early RA, even the incidence within 3 months, there can be joint bone destruction. The results show that:RA early onset is a critical window of opportunity for clinical treatment of early active and effective treatment can prevent or delay bone destruction in patients to avoid joint deformity, is expected to terminate the disease progression and improve quality of life, so that patients Continue to maintain the ability to work. RA more than the number of patients, the prevalence rate of 0.32～0.34% RA, the total number of 500 million sick about RA. Current treatment of rheumatoid arthritis drugs are hormones (hormone) drugs. on behalf of pharmaceutical prednisone, non-steroidal anti-inflammatory drugs (NSAIDs), on behalf of drug loxoprofen sodium, biological agents, on behalf of the British Fuli Xi monoclonal antibody drugs To improve the condition antirheumatic drugs, such as methotrexate (MTX), leflunomide (LEF), azathioprine (AZA) and so on, anti-malarial drugs, such as hydroxychloroquine (HCQ), botanicals, such as Tripterygium Glycosides, TGP, etc.. Many studies show that the efficacy of combination therapy is superior to single drug only, but also much less adverse reactions. We compared MTX+CTX, LEF+CTX, MTX+LEF in RA treatment efficacy and safety for the treatment of RA to provide new ideas and methods.[Objective] The study further our understanding of cycle specific and cycle non-specific drugs of drug cyclophosphamide leflunomide (LEF+CTX), methotrexate and cyclophosphamide (MTX+CTX) and two cycles Methotrexate and leflunomide specific drug combination (MTX+LEF) effect of the differences between them, and abnormal liver function adverse events to find good efficacy, few adverse treatment for rheumatoid joint future Yan combined therapy ideas. [Method]-hospital rheumatology clinics, wards were randomly selected into the group of 92 long-term follow-up study, in which LEF+CTX group of 30 people. MTX+CTX group of 36, LEF+MTX group 26. Were recorded at baseline (0 week), 3 weeks,6 weeks.12 weeks. DAS28, number of joint swelling, joint tenderness, patient assessment of disease, the overall situation of VAS score, erythrocyte sedimentation rate (ESR), ACR20, ACR50, ACR70. Which, DAS28 scores range from 0 to 10. DAS is calculated with DAS28-3: DAS28-3=[0.56 (?)+0.28 (?)+0.70 Ln (ESR)]×1.08+0.16 Note:TJC28 was to evaluate the joint tenderness in 28 joints number; SJC28 was to evaluate the 28 joint swollen joint count.12W each group were also recorded liver damage and the incidence of other adverse reactions, as for the safety of three treatment programs make evaluations.ACR20 ACR50 ACR70 improvementFormula:(pre-treatment value-treatment value)/pretreatment value x 100% ACR20TJC (tender joint counts) and SJC (swollen joint count) were more than 20% improvement;The following five indicators that at least three or more receive a 20% improvement:(1) patient assessment of pain VAS scores;(2) the overall situation of the patient assessment of disease, VAS score;(3) medical assessment of the overall situation of VAS score of disease;(4) HAQ;(5) CRP or ESR levels;ACR50 ACR70 improvement of these indicators were 50% and 70%.Statistical methods:1, ANOVA comparison between groups2, pairwise comparisons using SNK-q test3, when the variance of arrhythmia, the use of pairwise comparison DunnettT34, application SPSS10.0 statistical software analysis, a significant value of 0.05 points[Results] The three groups at baseline DAS28, ESR, patient assessment of the overall situation of the disease VAS score, the number of joint swelling, joint tenderness with anv two, with DunnettT3 test, P values were found in> 0.05, indicating that these three sets of data does not exist Statistically significant.12 weeks LEF+CTX group and the MTX+CTX group DAS28, ESR, patient assessment of the overall situation of the disease VAS score, the number of joint swelling, joint tenderness P> 0.05, no significant difference. MTX+CTX group compared with MTX+LEF DAS28, ESR, patient assessment of the overall situation of the disease VAS score, the number of joint swelling, joint tenderness P<0.05, LEF+CTX group compared with MTX+LEF DAS28, ESR, Assess the overall situation of the disease in patients with VAS score, the number of joint swelling, joint tenderness P<0.05, MTX+LEF group, DAS28, ESR, patient assessment of the overall situation of the disease VAS score, the number of joint swelling, joint tenderness values than the other two Group, and were statistically significant. After treatment,12W, ACR20, ACR50, ACR70 improvement rate comparison:MTX+CTX ACR20, ACR50 highest three groups P> 0.05; ACR70 three groups were O.Three groups at 12 weeks the incidence of abnormal liver function every two, with the X2 test, MTX+CTX group and the MTX+LEF group X2=24.544, P<0.05, significant difference between the two sets of data; LEF+CTX group With MTX+LEF group X2=16.29, P<0.05, significant difference between the two sets of data; LEF+CTX group and the MTX+CTX group X2=0.214, P> 0.05, there is no statistical between the two sets of data School differences.【Conclusions】1. Cycle specific drugs and cycle non-specific drugs LEF+CTX group and the MTX +CTX group combined a synergistic effect, its efficacy was significantly better than the cycle specific drugs in combination MTX+LEF group. LEF+CTX group and the MTX+CTX group2. Cycle specific drugs in combination MTX+LEF group the incidence of liver dysfunction was significantly higher than non-cycle specific drugs and specific drugs for another two cycles LEF+CTX group and the MTX+CTX group.