ZNAČAJ DOBRE ADHERENCIJE NA METOTREKSAT U LEČENJU REUMATOIDNOG ARTRITISA

  • Jelena Ceranic VMA, Klinika za reumatologiju
  • Darija Kisić Tepavčević
  • Gorica Ristić
DOI: https://doi.org/10.5937/mp76-46065
Ključne reči: reumatoidni artritis, adherencija, metotreksat, terapija

Sažetak


Reumatoidni artritis (RA) je hronično zapaljensko autoimuno oboljenje koje karakteriše simetrični periferni poliartritisa i progresivno oštećenje zglobova. Antireumatski lekovi koji modifikuju tok bolesti (BML) smanjuju aktivnost bolesti, radiološku progresiju na zglobovima i poboljšavaju dugoročni funkcionalni status pacijenata sa RA. Međutim, preduslov za ove pozitivne ishode je adekvatno pridržavanje pacijenata BML terapiji. Prema preporukama Evropske lige protiv reumatizma (The European Alliance of Associations for Rheumatology-EULAR) iz 2022.g. metotreksat (MTX) je i dalje lek prve linije za lečenje RA. Odlikuju ga pre svega bezbednost i efikasnost, različiti načini primene, mogućnost titracije doze kao i mali troškovi lečenja. Može se koristiti kao monoterapija ili u kombinaciji sa drugim sintetskim ili biološkim BML. Metotreksat je antimetabolit, strukturni analog folne kiseline, koji pored inhibicije de novo sinteze purina i pirimidina, potrebnih za sintezu DNK i RNK, deluje na upalu i drugim mehanizmima kao što su pojačano oslobađanje adenozina, inhibicija reakcije transmetilacije, smanjena akumulacija poliamini i odvajanje azot oksid sintaze. Metotreksat utiče na funkciju skoro svih tipova ćelija uključenih u zapaljenje RA (neutrofila, monocita, T ćelija, B ćelija, endotelnih ćelija i sinovioca sličnih fibroblastima). Međutim, nemaju svi pacijenti dobar odgovor na MTX, a to se delimično može objasniti i nepridržavanjem terapiji. Stopa adherencije varira između 59% i 107%, gde i prekomerna upotreba MTX takođe predstavlja problem adherencije. Optimalna upotreba MTX podrazumeva započinjanje terapije bez odlaganja, pridržavanje tačno preporučenoj dozi i režimu uzimanja leka do postizanja zadovoljavajućeg odgovora na terapiju, a zatim pridržavanje dozi održavanja. Indentifikovano je više od 200 varijabli koji utiču na adherenciju, ali nijedna od tih varijabli nije bila dosledno povezana u svim dosadašnjim istraživanjima, odnosno nije moguće kreirati odredjeni profil rizika za neadherenciju. S obzirom na ovu činjenicu i postojanje značajnog broja neadherentnih pacijenata, nameće se potreba za pronalaženje prilagođenih intervencija za poboljšanje adherencije na MTX kod pacijenata sa RA koje bi mogle poboljšati krajnje ishode same bolesti.

 

 

 

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Objavljeno
2025/05/09
Broj časopisa
Vol. 76 Br. 1 (2025): Medicinski podmladak
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