Finckh Axel, Simard Julia F, Duryea Jeffrey, Liang Matthew H, Huang Jie, Daneel Synove, Forster Adrian, Gabay Cem, Guerne Pierre-André
Robert B. Brigham Atthritis and Musculoskeletal Diseases Clinical Research Center, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
Arthritis Rheum. 2006 Jan;54(1):54-9. doi: 10.1002/art.21491.
To compare the effectiveness of 3 therapeutic strategies in preventing progressive joint damage, in a population-based cohort. The 3 strategies were infliximab with concomitant disease-modifying antirheumatic drugs (DMARDs), etanercept with concomitant DMARDs, and etanercept alone.
We used sequential radiographs to assess all patients who were treated with infliximab or etanercept for >10 months. The rates of erosion progression and joint space narrowing (JSN) were analyzed using multivariate regression models for longitudinal data, with adjustment for potential confounders.
A total of 372 patients treated with anti-tumor necrosis factor (TNF) therapies met the inclusion criteria. The baseline characteristics of the patients assigned to the 3 strategies were not significantly different, except that, as expected, more patients were receiving combination therapy with infliximab. The combination of infliximab plus DMARDs was significantly more effective than etanercept alone for controlling erosion progression (P < 0.001), but the effectiveness of the 2 combination-treatment strategies was similar (P = 0.07). The combination of infliximab plus DMARDs was also more effective at controlling progressive JSN compared with etanercept alone (P = 0.04) or etanercept plus DMARDs (P = 0.02). Treatment with anti-TNF agents (infliximab or etanercept) plus concomitant DMARDs was more effective than treatment with etanercept alone for controlling erosion progression (P = 0.045).
When combined with traditional DMARDs, both etanercept and infliximab appear to offer similar protection against progressive structural joint damage, and combination therapy with either of these agents appears to be more effective than treatment with etanercept alone.
在一项基于人群的队列研究中，比较三种治疗策略预防关节进行性损伤的有效性。这三种策略分别是英夫利昔单抗联合改善病情抗风湿药（DMARDs）、依那西普联合DMARDs以及单独使用依那西普。
我们使用系列X线片评估所有接受英夫利昔单抗或依那西普治疗超过10个月的患者。使用纵向数据的多变量回归模型分析侵蚀进展率和关节间隙狭窄（JSN），并对潜在混杂因素进行校正。
共有372例接受抗肿瘤坏死因子（TNF）治疗的患者符合纳入标准。分配到三种策略的患者的基线特征无显著差异，但正如预期的那样，接受英夫利昔单抗联合治疗的患者更多。英夫利昔单抗加DMARDs联合治疗在控制侵蚀进展方面明显比单独使用依那西普更有效（P<0.001），但两种联合治疗策略的有效性相似（P=0.07）。与单独使用依那西普（P=0.04）或依那西普加DMARDs（P=0.02）相比，英夫利昔单抗加DMARDs联合治疗在控制进行性JSN方面也更有效。抗TNF药物（英夫利昔单抗或依那西普）联合DMARDs治疗在控制侵蚀进展方面比单独使用依那西普更有效（P=0.045）。
与传统DMARDs联合使用时，依那西普和英夫利昔单抗在预防关节结构进行性损伤方面似乎提供了相似的保护，并且这两种药物的联合治疗似乎比单独使用依那西普更有效。
