肿瘤坏死因子抑制剂治疗与早期类风湿关节炎患者急性冠状动脉综合征风险
Treatment with tumor necrosis factor inhibitors and the risk of acute coronary syndromes in early rheumatoid arthritis.
作者信息
Ljung Lotta, Simard Julia F, Jacobsson Lennart, Rantapää-Dahlqvist Solbritt, Askling Johan
机构信息
Department of Medicine/Rheumatology, Umeå University Hospital, Umeå, Sweden.
出版信息
Arthritis Rheum. 2012 Jan;64(1):42-52. doi: 10.1002/art.30654.
OBJECTIVE
Rheumatoid arthritis (RA) is associated with an increased risk of ischemic heart disease, in both early and established RA. Data on the risk of ischemic heart disease in relation to therapy with tumor necrosis factor (TNF) antagonists (anti-TNF) are conflicting in patients with established RA and essentially lacking in those with early RA. In established RA, the risk of myocardial infarction has been linked to the response to anti-TNF therapies. The aim of this study was to determine the risk of acute coronary syndromes (ACS) in patients with early RA in relation to treatment with, and response to, anti-TNF.
METHODS
A cohort consisting of patients in whom RA was diagnosed between 1999 and 2007 was identified from the Swedish Rheumatology Register (n=6,000), from which information on disease activity and pharmacologic treatments was extracted. In a cohort study, the risk of first occurrence of an ACS was compared between patients treated with anti-TNF and those without exposure to anti-TNF, using hazard ratios (HRs). In a nested case-control study, the relationship between response to anti-TNF according to the European League Against Rheumatism (EULAR) response criteria and the risk of ACS was investigated.
RESULTS
In the cohort study, treatment with anti-TNF was not related to any statistically significant alteration in the risk of ACS (HR 0.80, 95% confidence interval [95% CI] 0.52-1.24). In the nested case-control study, a good or moderate EULAR treatment response at 3 months and at 6 months was not associated with a risk of ACS (odds ratio [OR] 1.7, 95% CI 0.5-5.1 and OR 1.5, 95% CI 0.3-6.9, respectively), when adjusted for disease activity before treatment start.
CONCLUSION
In this study of patients treated with anti-TNF within the first years of RA, neither treatment with, nor response to, anti-TNF therapy could be linked to any statistically significant decrease in the risk of ACS.
目的
类风湿关节炎（RA）患者，无论处于疾病早期还是确诊期，患缺血性心脏病的风险均会增加。关于肿瘤坏死因子（TNF）拮抗剂（抗TNF）治疗与缺血性心脏病风险之间的关系，确诊RA患者的数据存在冲突，而早期RA患者的数据基本缺失。在确诊RA患者中，心肌梗死风险与抗TNF治疗反应有关。本研究旨在确定早期RA患者使用抗TNF治疗及其反应与急性冠状动脉综合征（ACS）风险之间的关系。
方法
从瑞典风湿病登记处确定了一个队列，该队列由1999年至2007年间诊断为RA的患者组成（n = 6000），从中提取了疾病活动和药物治疗信息。在一项队列研究中，使用风险比（HR）比较接受抗TNF治疗的患者和未接受抗TNF治疗的患者首次发生ACS的风险。在一项巢式病例对照研究中，根据欧洲抗风湿病联盟（EULAR）反应标准，研究抗TNF反应与ACS风险之间的关系。
结果
在队列研究中，抗TNF治疗与ACS风险的任何统计学显著变化均无关（HR 0.80，95%置信区间[95%CI] 0.52 - 1.24）。在巢式病例对照研究中，在调整治疗开始前的疾病活动后，3个月和6个月时EULAR治疗反应良好或中等与ACS风险无关（优势比[OR]分别为1.7，95%CI 0.5 - 5.1和OR 1.5，95%CI 0.3 - 6.9）。
结论
在这项对RA发病头几年接受抗TNF治疗的患者的研究中，抗TNF治疗及其反应均与ACS风险的任何统计学显著降低无关。
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