Oleh Admin Kalbe Medical pada November 28, 2017 07:00

Kombinasi Adalimumab + Methotrexate Efektif untuk Pengobatan Penyakit Rheumatoid Arthritis

Rheumatoid arthritis (RA) atau yang lebih dikenal dengan penyakit rematik adalah penyakit autoimun sistemik dengan gejala radang pada sendi, manifestasi kulit, dan gejala fatigue secara umum. Prevalensi penyakit ini mengenai 1% dari populasi. Menurut panduan, pengobatan lini pertama dari penyakit ini adalah menggunakan disease modifying antirheumatic drugs (DMARDs), contohnya methotrexate. Akan tetapi, sebagian pasien tidak berespons dengan penggunaan methotrexate, sehingga membutuhkan pengobatan tambahan. Menurut panduan, apabila pasien RA tidak berespons dengan pengobatan monoterapi DMARD, maka ada 4 pilihan yaitu: kombinasi DMARD, atau anti-TNF (contohnya adalimumab, golimumab, infliximab, atau etanercept), atau biologik non-TNF (contohnya anti-IL6 yaitu tocilizumab), atau tofacitinib (suatu Janus Kinase Inhibitor).

Salah satu mediator yang menjadi penyebab proses peradangan pada rheumatoid arthritis adalah tumor necrosis factor (TNF- α). Adalimumab adalah monoclonal antibody yang bekerja dengan cara menghambat TNF-α. Oleh karena itu, adalimumab dapat digunakan sebagai pengobatan tambahan apabila pasien rheumatoid arthritis tidak mengalami perbaikan gejala pada pengobatan methotrexate saja.

Dr. Keystone dan tim dari Kanada, USA, dan Eropa melakukan sebuah uji klinik yang diterbitkan di jurnal Rheumatic and Muskuloskeletal Disease yang mengevaluasi efektivitas kombinasi adalimumab + methotrexate dibandingkan dengan methotrexate saja (dosis adalimumab yang dipakai adalah 40 mg setiap 2 minggu). Dr. Keystone dan tim menganalisis data dari 3 uji klinik. Parameter yang dievaluasi adalah proporsi pasien yang gejalanya terkontrol secara sempurna (mencapai comprehensive disease control/CDC) pada 52 minggu (1 tahun) pengobatan. Hasil yang didapatkan adalah secara umum proporsi pasien yang gejalanya terkontrol sempurna (mencapai CDC) setelah 1 tahun pengobatan pada kelompok kombinasi adalimumab+methotrexate adalah 25% dan pada kelompok methrotrexate saja adalah 14%.

Kesimpulan:
Penelitian ini menyimpulkan bahwa pada pasien rheumatoid arthritis, pengobatan selama 1 tahun menggunakan kombinasi adalimumab + methotrexate menghasilkan lebih banyak pasien yang gejalanya terkontrol sempurna dibandingkan dengan pengobatan methotrexate saja. (NNO)

Image : Ilustrasi
Referensi:
1.Rheumatoid arthritis: Practice essentials, background, pathophysiology [Internet]. 2017 Sep 15 [cited 2017 Nov 16]. Available from: https://emedicine.medscape.com/article/331715-overview?pa=4JAiSOD2bqAjh1m3Ap7afQrzBinnBIJPK3fsk4GA44Jtu60FPCpuQWEWR6eNGgmSGkjYnodGhKIMjjcj%2FPnB7g1itYOJvq1xBPinVjl4%2Fvk%3D
2.Keystone EC, Breedveld FC, van der Heijde D, van Vollenhoven RF, Emery P, Smolen JS, et al. Achieving comprehensive disease control in patients with early and established rheumatoid arthritis treated with adalimumab plus methotrexate versus methotrexate alone. RMD Open. 2017;3(2):e000445.

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