Low-Dose Methotrexate for the Prevention of Atherosclerotic Events
Rattachement africain : us, ca, ie. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
BACKGROUND: Inflammation is causally related to atherothrombosis. Treatment with canakinumab, a monoclonal antibody that inhibits inflammation by neutralizing interleukin-1β, resulted in a lower rate of cardiovascular events than placebo in a previous randomized trial. We sought to determine whether an alternative approach to inflammation inhibition with low-dose methotrexate might provide similar benefit. METHODS: We conducted a randomized, double-blind trial of low-dose methotrexate (at a target dose of 15 to 20 mg weekly) or matching placebo in 4786 patients with previous myocardial infarction or multivessel coronary disease who additionally had either type 2 diabetes or the metabolic syndrome. All participants received 1 mg of folate daily. The primary end point at the onset of the trial was a composite of nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. Near the conclusion of the trial, but before unblinding, hospitalization for unstable angina that led to urgent revascularization was added to the primary end point. RESULTS: The trial was stopped after a median follow-up of 2.3 years. Methotrexate did not result in lower interleukin-1β, interleukin-6, or C-reactive protein levels than placebo. The final primary end point occurred in 201 patients in the methotrexate group and in 207 in the placebo group (incidence rate, 4.13 vs. 4.31 per 100 person-years; hazard ratio, 0.96; 95% confidence interval [CI], 0.79 to 1.16). The original primary end point occurred in 170 patients in the methotrexate group and in 167 in the placebo group (incidence rate, 3.46 vs. 3.43 per 100 person-years; hazard ratio, 1.01; 95% CI, 0.82 to 1.25). Methotrexate was associated with elevations in liver-enzyme levels, reductions in leukocyte counts and hematocrit levels, and a higher incidence of non-basal-cell skin cancers than placebo. CONCLUSIONS: Among patients with stable atherosclerosis, low-dose methotrexate did not reduce levels of interleukin-1β, interleukin-6, or C-reactive protein and did not result in fewer cardiovascular events than placebo. (Funded by the National Heart, Lung, and Blood Institute; CIRT ClinicalTrials.gov number, NCT01594333.).
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Low-Dose Methotrexate for the Prevention of Atherosclerotic Events
- Date Crossref
- 21/02/2019
- Éditeur
- Massachusetts Medical Society
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Brigham and Women's Hospital Divisions of Cardiovascular Medicine pays non établi dans la noticeÉtablissement de santé
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and Blood Institute Lung pays non établi dans la noticeStructure de recherche
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McMaster University Brigham and Women’s Hospital pays non établi dans la noticeUniversité ou école supérieure
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Canadian Respiratory Research Network pays non établi dans la noticeOrganisation à but non lucratif
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St Michael’s Hospital pays non établi dans la noticeÉtablissement de santé
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Touro University California pays non établi dans la noticeUniversité ou école supérieure
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Asheville Cardiology Associates pays non établi dans la noticeInstitution
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Community Hospital pays non établi dans la noticeÉtablissement de santé
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Dayton VA Medical Center pays non établi dans la noticeÉtablissement de santé
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Cotton (United States) pays non établi dans la noticeEntreprise
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Valley Medical Center pays non établi dans la noticeÉtablissement de santé
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University of Ottawa pays non établi dans la noticeUniversité ou école supérieure
Divisions of Cardiovascular Medicine — Brigham and Women's Hospital, Lung — and Blood Institute et Brigham and Women’s Hospital — McMaster University, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.