Ramiro Sofia, Roque Raquel, Vinagre Filipe, Cordeiro Ana, Tavares Viviana, Van Tubergen Astrid, Canas da Silva J, Landewé Robert, Santos M José
Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal.
Acta Reumatol Port. 2011 Jul-Sep;36(3):234-42.
To investigate the switches performed in patients with rheumatoid arthritis under biological therapy and specifically comparing the switches from earlier days with more recent switches.
Patients with rheumatoid arthritis under biological therapy followed at Hospital Garcia de Orta, Almada, and included in the Rheumatic Diseases Portuguese Register (Reuma.Pt) were included in this study. Switches occurring before and after January 2007 were compared with respect to patients' demographic and clinical characteristics, such as disease activity and duration of biological therapy. The survival of the first biological agent was compared between patients starting biological therapy before and after 2007. EULAR response and remission rate at the last evaluation were calculated. Comparisons between groups were established using a t-test or chi--square, as appropriate. Survival curves of the first biological were compared through the logrank test.
In total, 123 patients were included in the analysis (mean age 57.0 ± 13.1 years and mean disease duration 11.7 ± 8.0 years). A total of 85 switches were documented, 20% of which took place before 2007. Comparing the switches before and after 2007, the latter were registered among older patients (recent switches 56.2 ± 12.9 years vs older switches 48.9 ± 11.0 years, p=0.04) and with a shorter duration of the first biological agent (recent switches 461.9 ± 293.2 days vs older switches 773.7 ± 475.8 days, p=0.03). No further significant differences were found, including the disease activity. The survival of the first biological was shorter in patients starting biological therapy after 2007 (2949 days for biological onset before 2007 and 818 days for onset after 2007, p <0.001). A good EULAR response was achieved by 19% and 30% of the patients, before and after 2007, respectively (p = 0.23). Remission was achieved by 14% and 22% of the patients, before and after 2007, respectively (p = 0.30).
Switches were more frequently performed in more recent years, in older patients and with a shorter duration of biological therapy. A trend towards a better and more targeted control of the disease could be discussed in light of our results. Although switches were more frequently performed in more recent years, in older patients and with a shorter duration of biological therapy, there is still room for improvement when aiming at remission, for example by applying a tighter therapy strategy like the "treat to target model".
调查类风湿关节炎患者在生物治疗过程中的换药情况，并特别比较早期换药与近期换药的差异。
本研究纳入了在阿尔马达加西亚·德奥尔塔医院接受生物治疗并被纳入葡萄牙风湿病登记册（Reuma.Pt）的类风湿关节炎患者。比较了2007年1月前后发生的换药情况，涉及患者的人口统计学和临床特征，如疾病活动度和生物治疗持续时间。比较了2007年前后开始生物治疗的患者中第一种生物制剂的使用时长。计算了最后一次评估时的欧洲抗风湿病联盟（EULAR）反应和缓解率。根据情况，使用t检验或卡方检验进行组间比较。通过对数秩检验比较第一种生物制剂的生存曲线。
总共123例患者纳入分析（平均年龄57.0±13.1岁，平均病程11.7±8.0年）。共记录了85次换药，其中20%发生在2007年之前。比较2007年前后的换药情况，发现近期换药的患者年龄较大（近期换药患者56.2±12.9岁，早期换药患者48.9±11.0岁，p = 0.04），且第一种生物制剂的使用时长较短（近期换药患者461.9±293.2天，早期换药患者773.7±475.8天，p = 0.03）。未发现其他显著差异，包括疾病活动度。2007年之后开始生物治疗的患者中第一种生物制剂的使用时长较短（2007年之前开始生物治疗的患者为2949天，2007年之后开始的患者为818天，p<0.001）。2007年之前和之后分别有19%和30%的患者获得了良好的EULAR反应（p = 0.23）。2007年之前和之后分别有14%和22%的患者实现了缓解（p = 0.30）。
近年来换药更频繁，多见于老年患者且生物治疗持续时间较短。根据我们的结果，可以讨论疾病控制向更好、更有针对性方向发展的趋势。尽管近年来换药更频繁，多见于老年患者且生物治疗持续时间较短，但在实现缓解方面仍有改进空间，例如通过应用更严格的治疗策略，如“治疗达标模式”。
