Rheumatology Unit, M. Scarlato Hospital, Scafati, 5, Via Passanti, 84018 Scafati (Sa), Italy.
Rheumatology (Oxford). 2010 Feb;49(2):289-94. doi: 10.1093/rheumatology/kep354. Epub 2009 Nov 17.
To identify the determinants of anti-TNF-naive patients' preferences for the route of administration of anti-TNF agents.
The study was carried out in 50 Italian rheumatology centres (802 patients). All patients completed a 31-item questionnaire addressing their perceptions of current treatment and the preferences for treatment with anti-TNF agents. Statistical methods included analysis of variance (ANOVA), t-test and chi-square test.
The response rate to the questionnaire was 97.6%. At the time of the survey, 310 (39.9%) patients were dissatisfied with current treatments, owing to inefficacy, side effects and inconvenience of administration. The i.v. and s.c. routes of administration were preferred by 50.2 and 49.8%, respectively. No significant difference was found in patients by gender, age, RA duration or number of drugs used. Reasons for the choice of i.v. administration were the safety of treatment at the hospital and the reassuring effect of physician presence. The s.c. administration was chosen for the convenience of treatment and in particular for home treatment. Patients dissatisfied with current therapy due to side effects preferred s.c. administration (P = 0.029), whereas patients choosing the i.v. route had slightly higher scores on 'today pain' (P = 0.047) and 'articular pain' (P = 0.023) of the Rheumatoid Arthritis Disease Activity Index (RADAI).
Both i.v. and s.c. treatments were well accepted by patients. However, treatment choice has to be discussed with patients, as individual preference seems to be determined by personal attitudes towards safety and convenience, by past experience and by the perception of current disease status.
确定抗 TNF 初治患者对 TNF 拮抗剂给药途径偏好的决定因素。
该研究在意大利的 50 个风湿病中心（802 例患者）进行。所有患者均完成了 31 项问卷，内容涉及他们对当前治疗的看法以及对 TNF 拮抗剂治疗的偏好。统计方法包括方差分析（ANOVA）、t 检验和卡方检验。
问卷的应答率为 97.6%。在调查时，310 例（39.9%）患者对当前的治疗不满意，原因是疗效不佳、副作用和给药不便。静脉注射和皮下注射给药途径的偏好率分别为 50.2%和 49.8%。性别、年龄、RA 病程或使用药物数量在患者之间无显著差异。选择静脉注射给药的原因是在医院治疗的安全性和医生在场的安慰作用。选择皮下给药是因为治疗方便，尤其是可以在家中治疗。因副作用而对当前治疗不满意的患者更倾向于皮下给药（P = 0.029），而选择静脉途径的患者在类风湿关节炎疾病活动指数（RADAI）的“今日疼痛”（P = 0.047）和“关节疼痛”（P = 0.023）方面的评分略高。
静脉和皮下治疗均被患者很好地接受。然而，必须与患者讨论治疗选择，因为个人偏好似乎取决于对安全性和便利性的个人态度、既往经验以及对当前疾病状况的感知。
