Difficulté de prédire la réponse clinique au méthotrexate chez les patients atteints de polyarthrite rhumatoïde : revue systématique de la littérature

Resume Objectifs Identifier, par une revue systematique de la litterature, les facteurs predictifs de reponse clinique au methotrexate chez des patients atteints de polyarthrite rhumatoide, afin de faciliter la mise en place d’un traitement personnalise. Methodes Les bases de donnees PubMed et Embase ont ete consultees pour la selection des articles originaux. Les abstracts des rencontres annuelles de l’EULAR (European League Against Rheumatism) et de l’ACR (American College of Rheumatology) de ces deux dernieres annees ont egalement ete examines. Ont ete inclus les articles decrivant les facteurs predictifs de la reponse clinique au methotrexate 3 a 6 mois suivant le debut du traitement, periode qui permet de determiner l’efficacite du traitement et d’envisager une adaptation therapeutique selon les recommandations treat-to-target. Resultats 30 articles ont ete inclus, contenant un total de 102 facteurs predictifs differents et 11 modeles predictifs. 19 facteurs et 2 modeles predictifs ont ete evalues au sein de plusieurs cohortes. Le sexe feminin est apparu comme etant un facteur predictif de non-reponse au cours de deux etudes (odds ratios 0,55 et 0,54) mais ces observations n’ont pas ete retrouvees dans deux autres etudes. Dans deux etudes, le tabagisme permettait de predire la non-reponse (odds ratios ajustes 0,35 et 0,60) mais ce resultat apparaissait contradictoire pour tous les criteres de reponse evalues. La positivite du facteur rhumatoide etait un marqueur predictif de non reponse dans deux etudes (hazard ratio ajuste 0,61, odds ratio ajuste 0,4) mais cette observation n’a pas ete retrouvee dans trois autres etudes. L’heterogeneite des etudes n’a pas permis de comparer les valeurs predictives entre les etudes. Par ailleurs, un modele epigenetique valide a ete retrouve (aire sous la courbe 0,90 et 0,91). Conclusions Aucun des facteurs ne permettait de predire de maniere fiable la reponse clinique au methotrexate apres 3 a 6 mois de traitement chez les patients : ces facteurs affichaient un faible pouvoir de prediction. Cependant, un modele epigenetique prometteur a ete trouve et reste a valider.

• Publication year

  2020

• Venue

  Revue du Rhumatisme

• Publication date

  2020-05-01

• Fields of study

  Not labeled

• Identifiers
  DOI 10.1016/j.rhum.2020.01.009
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar

• No claims are published for this paper.

• No concepts are published for this paper.

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