Monash Department of Clinical Epidemiology, Cabrini Hospital, and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Cabrini Institute, 183 Wattletree Rd, Malvern, Victoria, Australia 3144.
Rheumatology (Oxford). 2011 Jan;50(1):166-75. doi: 10.1093/rheumatology/keq322. Epub 2010 Oct 7.
To describe changes in health-related quality of life (HRQoL) up to 60 months after commencing anti-TNF therapy for RA patients enrolled in the Australian Rheumatology Association Database (ARAD), and to determine the continuation rate and predictors of discontinuation of first-line anti-TNF therapy.
Responses to the HAQ, Assessment of Quality of Life, Medical Outcomes Study Short Form-36 (SF-36) and European Quality of Life-5 Dimensions (EQ-5D) were extracted from ARAD for patients commencing anti-TNF therapy and analysed in 6-monthly intervals from the start date. Predictors of discontinuation of therapy were assessed using Cox regression.
Since September 2001, 2601 RA patients have enrolled in ARAD; 1801 have used anti-TNF therapy. Before starting the therapy, all HRQoL scores were below the population norms, but showed improvements in the first 6 months. From 12 to 60 months, HRQoL remained stable but below population means. Data to 60 months were available for 106 patients; 47% were still on first-line therapy at 5 years, all were using concurrent DMARDs and 55% were using concurrent prednisolone. Predictors of discontinuation of therapy were poorer HRQoL scores, a more recent therapy start date, concurrent prednisolone use and self-reported severe infection. Older patients and those with longer symptom duration were more likely to remain on therapy.
In routine practice, HRQoL scores improve rapidly within 6 months of starting anti-TNFs and then remain stable for up to 60 months. Almost half remain on first-line therapy.
描述接受抗 TNF 治疗的类风湿关节炎（RA）患者在澳大利亚风湿病协会数据库（ARAD）登记后 60 个月内健康相关生活质量（HRQoL）的变化，并确定一线抗 TNF 治疗的停药率及其停药的预测因素。
从 ARAD 中提取接受抗 TNF 治疗的患者的 HAQ、生活质量评估、医疗结果研究 36 项简明健康状况量表（SF-36）和欧洲五维健康量表（EQ-5D）的应答情况，并在起始日期后以 6 个月为间隔进行分析。使用 Cox 回归分析评估治疗停药的预测因素。
自 2001 年 9 月以来，2601 例 RA 患者在 ARAD 登记，其中 1801 例使用了抗 TNF 治疗。在开始治疗前，所有 HRQoL 评分均低于人群正常值，但在最初 6 个月内均有所改善。从 12 个月到 60 个月，HRQoL 保持稳定，但仍低于人群平均值。在第 60 个月时，106 例患者的数据可用；5 年后仍有 47%的患者继续使用一线治疗，所有患者均同时使用 DMARDs，55%的患者同时使用泼尼松龙。治疗停药的预测因素包括较差的 HRQoL 评分、较近的治疗开始日期、同时使用泼尼松龙和自我报告的严重感染。年龄较大的患者和症状持续时间较长的患者更有可能继续接受治疗。
在常规实践中，接受抗 TNF 治疗后 6 个月内 HRQoL 评分迅速改善，然后在 60 个月内保持稳定。近一半的患者仍在接受一线治疗。
