Fautrel Bruno, Constantin Arnaud, Morel Jacques, Vittecoq Olivier, Cantagrel Alain, Combe Bernard, Dougados Maxime, Le Loët Xavier, Mariette Xavier, Pham Thao, Puéchal Xavier, Sibilia Jean, Soubrier Martin, Ravaud Philippe
Service de Rhumatologie, Groupe Hospitalier Pitié-Salpêtrière, UFR de Médecine, Université Pierre et Marie-Curie-Paris-VI, 83, Boulevard de l'Hôpital, 75651 Paris cedex 13, France.
Joint Bone Spine. 2006 Jul;73(4):433-41. doi: 10.1016/j.jbspin.2006.04.001. Epub 2006 Jun 5.
To develop recommendations for TNFalpha-antagonist therapy in patients with rheumatoid arthritis (RA) seen in everyday practice, under the aegis of the French Society for Rheumatology.
We used the methods recommended by the French Agency for Healthcare Accreditation and Evaluation, the AGREE collaboration, and the European League against Rheumatism (EULAR). The recommendations focus on patient selection, monitoring, and treatment adjustments.
Criteria for selecting patients eligible for TNFalpha-antagonist treatment of RA include: 1) a definitive diagnosis of RA; 2) disease activity for longer than 1 month, including presence of objective signs of inflammation; or radiographic progression; 3) previous failure of methotrexate in the highest tolerated dosage or of another disease-modifying antirheumatic drug in patients with contraindications to methotrexate; 4) absence of contraindications to TNFalpha-antagonist therapy. When starting TNFalpha-antagonist therapy 1) a thorough baseline evaluation should be conducted; 2) any of the three available agents can be used, as no differences in efficacy have been identified in patient populations; 3) concomitant methotrexate therapy is recommended regardless of the TNFalpha antagonist used; and 4) patients should receive standardized follow-up at regular intervals. Treatment adjustments should be based on the following: 1) the treatment objective is achievement of a EULAR response; 2) when such a response is not achieved, the dosage or dosing interval can be changed, or the patient can be switched to another TNFalpha antagonist; 3) in patients who experience intolerance to a TNFalpha antagonist, another TNFalpha antagonist may be tried, depending on the nature of the adverse event; 4) occurrence of a remission should lead to a reduction in symptomatic medications, most notably glucocorticoids where used; in the event of a prolonged remission, either the TNFalpha antagonist or the concomitant disease-modifying antirheumatic drug may be reduced.
These recommendations are intended to help physicians use TNFalpha antagonists in their everyday practice with RA patients. They do not constitute regulations.
在法国风湿病学会的支持下，制定针对日常临床中类风湿关节炎（RA）患者使用肿瘤坏死因子α（TNFα）拮抗剂治疗的建议。
我们采用了法国医疗保健认证与评估机构、AGREE协作组织以及欧洲抗风湿病联盟（EULAR）推荐的方法。这些建议聚焦于患者选择、监测及治疗调整。
选择适合用TNFα拮抗剂治疗RA患者的标准包括：1）确诊为RA；2）疾病活动超过1个月，包括存在炎症客观体征或影像学进展；3）先前使用最大耐受剂量甲氨蝶呤治疗失败，或在有甲氨蝶呤禁忌证的患者中使用其他改善病情抗风湿药失败；4）无TNFα拮抗剂治疗的禁忌证。开始TNFα拮抗剂治疗时：1）应进行全面的基线评估；2）三种可用药物中的任何一种均可使用，因为在患者群体中未发现疗效差异；3）无论使用何种TNFα拮抗剂，均建议联合甲氨蝶呤治疗；4）患者应定期接受标准化随访。治疗调整应基于以下几点：1）治疗目标是达到EULAR反应；2）未达到该反应时，可改变剂量或给药间隔，或换用另一种TNFα拮抗剂；3）对TNFα拮抗剂不耐受的患者，可根据不良事件的性质尝试换用另一种TNFα拮抗剂；4）病情缓解应导致症状性药物减少，尤其是使用糖皮质激素时；若缓解持续时间较长，可减少TNFα拮抗剂或联合使用的改善病情抗风湿药。
这些建议旨在帮助医生在日常临床中对RA患者使用TNFα拮抗剂。它们不构成法规。
