Braun-Moscovici Yolanda, Markovits Doron, Rozin Alexander, Toledano Kochava, Nahir A Menahem, Balbir-Gurman Alexandra
B Shine Department of Rheumatology, Rambam Medical Health Care Campus, Technion, Haifa, Israel.
Isr Med Assoc J. 2008 Apr;10(4):277-81.
Infliximab and etanercept have been included in the Israeli national list of health services since 2002 for rheumatoid arthritis and juvenile idiopathic arthritis, and since 2005 for psoriatic arthritis and ankylosing spondylitis. The regulator (Ministry of Health and health funds) mandates using fixed doses of infliximab as the first drug of choice and prohibits increased dosage. For other indications (e.g., vasculitis), anti-tumor necrosis factor therapy is given on a "compassionate" basis in severe refractory disease.
To describe our experience with anti-TNF therapy in a single tertiary referral center in northern Israel and to analyze the impact of the national health policy on the results.
We reviewed the medical records of patients who received anti-TNF therapy in our institution, and analyzed demographic data, diagnosis, clinical and laboratory features, previous and current therapies, and anti-TNF treatment duration and side effects.
Between 2001 and 2006, 200 patients received anti-TNF therapy for rheumatoid arthritis (n = 108), juvenile idiopathic arthritis (n = 11), psoriatic arthritis (n = 37), ankylosing spondylitis (n = 29), adult Still's disease (n = 4), overlap disease (RA and scleroderma or polymyositis, n = 6), temporal arteritis (n = 1), polyarteritis nodosa (n = 1), dermatomyositis (n = 1), amyloidosis secondary to RA (n = 1) and Wegener's granulomatosis (n = 1). Forty percent of RA patients discontinued the first anti-TNF agent due to side effects or insufficient response. Higher sedimentation rate and lower or negative rheumatoid factor predicted better response to therapy among RA patients. AS and PS patients had a better safety and efficacy profile. Severe infections occurred in 2% of patients. All eight patients who presented lung involvement as part of their primary rheumatic disease remained stable or improved. A significant improvement was achieved in all six patients with overlap disease.
Our daily practice data are generally in agreement with worldwide experience. The 'deviations' might be explained by the local health policy at that time. The impact of health policy and economic and administrative constraints should be taken into account when analyzing cohort daily practice data.
自2002年起，英夫利昔单抗和依那西普被列入以色列医疗卫生服务国家清单，用于治疗类风湿关节炎和幼年特发性关节炎，自2005年起用于治疗银屑病关节炎和强直性脊柱炎。监管机构（卫生部和医保基金）规定将固定剂量的英夫利昔单抗作为首选药物，并禁止增加剂量。对于其他适应症（如血管炎），在严重难治性疾病中，抗肿瘤坏死因子治疗是在“同情用药”的基础上进行的。
描述我们在以色列北部一家三级转诊中心进行抗肿瘤坏死因子治疗的经验，并分析国家卫生政策对治疗结果的影响。
我们回顾了在本机构接受抗肿瘤坏死因子治疗的患者的病历，并分析了人口统计学数据、诊断、临床和实验室特征、既往和当前治疗情况以及抗肿瘤坏死因子治疗的持续时间和副作用。
2001年至2006年间，200例患者接受了抗肿瘤坏死因子治疗，其中类风湿关节炎患者108例，幼年特发性关节炎患者11例，银屑病关节炎患者37例，强直性脊柱炎患者29例，成人斯蒂尔病患者4例，重叠综合征（类风湿关节炎合并硬皮病或多发性肌炎）患者6例，颞动脉炎患者1例，结节性多动脉炎患者1例，皮肌炎患者1例，类风湿关节炎继发淀粉样变性患者1例，韦格纳肉芽肿患者例。40%的类风湿关节炎患者因副作用或反应不足而停用了第一种抗肿瘤坏死因子药物。较高的血沉率和较低或阴性的类风湿因子预示类风湿关节炎患者对治疗反应较好。强直性脊柱炎和银屑病关节炎患者的安全性和疗效更好。2%的患者发生了严重感染。所有8例以肺部受累作为原发性风湿性疾病一部分的患者病情保持稳定或有所改善。所有6例重叠综合征患者均有显著改善。
我们的日常实践数据总体上与全球经验一致。这些“偏差”可能是由当时的地方卫生政策所解释的。在分析队列日常实践数据时，应考虑卫生政策以及经济和行政限制的影响。
