Division of Rheumatology, University of Pavia, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy.
Autoimmun Rev. 2010 Apr;9(6):465-9. doi: 10.1016/j.autrev.2009.12.010. Epub 2009 Dec 31.
New biologic agents have changed the paradigm of rheumatoid arthritis treatment, leading to improvement in managing patients' refractory to classical DMARDs. Anti-TNF-alpha is used as first-line treatment in patients failing to respond to classical DMARDs. However, up to 50% of patients fail to respond to these drugs or develop adverse events leading to treatment discontinuation: in these cases the optimal treatment strategy is still a matter of debate even if trying with a second anti-TNF-alpha is considered a good option. We report data of patients switching from a first to a second anti-TNF-alpha from an Italian registry of patients with rheumatoid arthritis, showing that switching is valuable in patients stopping a first anti-TNFalpha drug. The patients with higher disease activity levels and those stopping the first anti-TNFalpha treatment because of a lack of efficacy are very likely to respond to the second treatment.
新型生物制剂改变了类风湿关节炎的治疗模式，使那些对经典 DMARDs 反应不佳的患者得到了更好的管理。抗 TNF-α 被用作对经典 DMARDs 反应不佳的患者的一线治疗药物。然而，多达 50%的患者对这些药物没有反应或出现导致治疗中断的不良反应：在这些情况下，即使尝试使用第二种抗 TNF-α 药物也被认为是一种较好的选择，最佳的治疗策略仍存在争议。我们报告了意大利类风湿关节炎患者登记处中患者从一种抗 TNF-α 药物转换为另一种抗 TNF-α 药物的数据，结果表明，在停止使用第一种抗 TNFα 药物的患者中，转换治疗是有价值的。那些疾病活动水平较高和因疗效不佳而停止使用第一种抗 TNFα 治疗的患者，很可能对第二种治疗有反应。
