Di Poi E, Perin A, Morassi M P, Del Frate M, Ferraccioli G F, De Vita S
Division of Rheumatology, DPMSC,School of Medicine, University of Udine, Udine, Italy.
Clin Exp Rheumatol. 2007 Jan-Feb;25(1):85-7.
TNF-alpha is thought to play a pivotal role in the initiation and perpetuation of the chronic inflammatory process in rheumatoid arthritis. TNF-alpha blockers such as infliximab and etanercept are currently used in the treatment of active rheumatoid arthritis (RA) when traditional DMARDs have failed and are effective in a significant proportion of patients. However, about one third are non-responders to anti-TNF-alpha. The aim of this study was to verify whether rheumatoid patients, after failing infliximab, can benefit from etanercept. We analysed 18 patients with active RA with no response to at least 3 DMARDs and where infliximab therapy had failed. The patients had received infliximab associated with methotrexate: eleven of them did not show any significant response, while seven patients, after a good response, relapsed. Etanercept was then started. EULAR criteria of response were used with calculation of activity index DAS28 at baseline, after 2 weeks, 3 months and every third month until last follow-up. A moderate or good response was achieved with etanercept in 13 out of 18 patients. From our experience, etanercept can be considered as a good alternative choice when infliximab has failed.
肿瘤坏死因子-α（TNF-α）被认为在类风湿关节炎慢性炎症过程的启动和持续中起关键作用。当传统改善病情抗风湿药（DMARDs）治疗失败时，英夫利昔单抗和依那西普等TNF-α阻滞剂目前用于治疗活动性类风湿关节炎（RA），并且在相当一部分患者中有效。然而，约三分之一的患者对抗TNF-α治疗无反应。本研究的目的是验证类风湿患者在英夫利昔单抗治疗失败后是否能从依那西普中获益。我们分析了18例活动性RA患者，这些患者对至少3种DMARDs无反应且英夫利昔单抗治疗失败。患者接受了英夫利昔单抗联合甲氨蝶呤治疗：其中11例未显示任何显著反应，而7例患者在有良好反应后复发。然后开始使用依那西普。采用欧洲抗风湿病联盟（EULAR）反应标准，在基线、2周、3个月以及直至最后一次随访的每三个月计算疾病活动指数DAS28。18例患者中有13例使用依那西普后获得中度或良好反应。根据我们的经验，当英夫利昔单抗治疗失败时，依那西普可被视为一个不错的替代选择。
