Mayo Clinic, Rochester, Minnesota, USA.
Arthritis Care Res (Hoboken). 2012 Jul;64(7):1079-83. doi: 10.1002/acr.21636.
To report a single-center experience with the use of tumor necrosis factor (TNF) inhibitors in patients with Takayasu arteritis (TA).
We retrospectively studied a cohort of patients with refractory TA evaluated at our institution and treated with TNF inhibitors. American College of Rheumatology criteria for TA were used for inclusion. Disease activity was assessed according to the National Institutes of Health criteria.
We included 20 patients (19 women, 17 white) with a mean ± SD age of 33 ± 10.2 years and a median disease duration of 15.9 months (interquartile range [IRQ] 2-32.7 months) prior to the use of TNF inhibitors. Before the use of TNF inhibitors, all 20 patients received prednisone. Other medication use included methotrexate (18 patients), azathioprine (5 patients), mycophenolate mofetil (3 patients), and cyclophosphamide (3 patients). Seventeen patients (85%) received infliximab, 2 patients (10%) received adalimumab, and 1 patient (5%) received etanercept. The median duration of treatment with TNF inhibitors was 23.0 months (IQR 8.7-38.9 months). Treatment with TNF inhibitors resulted in disease remission in 18 (90%) of 20 patients and sustained remission in 10 patients (50%). Ten (83%) of 12 patients were able to taper prednisone below 10 mg and 7 patients discontinued prednisone. However, 6 of the 18 patients achieving remission experienced relapse while receiving TNF inhibitors. Eleven patients (55%) discontinued TNF inhibitors for the following reasons: relapse, persistently active disease, lack of corticosteroid-sparing effect, adverse effects (4 patients), and other reasons (4 patients).
In this study, treatment with TNF inhibitors induced remission, including sustained remission in patients with refractory TA. However, 33% of patients experienced disease relapse while receiving TNF inhibitors and 20% discontinued treatment because of adverse events.
报告使用肿瘤坏死因子（TNF）抑制剂治疗 Takayasu 动脉炎（TA）患者的单中心经验。
我们回顾性研究了在我院评估并接受 TNF 抑制剂治疗的难治性 TA 患者队列。使用美国风湿病学会（ACR）TA 标准纳入患者。根据美国国立卫生研究院（NIH）标准评估疾病活动度。
我们纳入了 20 名患者（19 名女性，17 名白人），平均年龄为 33 ± 10.2 岁，中位数疾病病程为 15.9 个月（四分位距 [IQR] 2-32.7 个月），在使用 TNF 抑制剂之前。在使用 TNF 抑制剂之前，所有 20 名患者均接受了泼尼松治疗。其他药物包括甲氨蝶呤（18 名患者）、硫唑嘌呤（5 名患者）、霉酚酸酯（3 名患者）和环磷酰胺（3 名患者）。17 名患者（85%）接受了英夫利昔单抗治疗，2 名患者（10%）接受了阿达木单抗治疗，1 名患者（5%）接受了依那西普治疗。TNF 抑制剂治疗的中位持续时间为 23.0 个月（IQR 8.7-38.9 个月）。TNF 抑制剂治疗后，20 名患者中有 18 名（90%）疾病缓解，10 名（50%）患者缓解持续。12 名患者中有 10 名（83%）能够将泼尼松减至 10 mg 以下，7 名患者停用了泼尼松。然而，在接受 TNF 抑制剂治疗的过程中，18 名缓解患者中有 6 名出现复发。11 名患者（55%）因以下原因停用 TNF 抑制剂：复发、持续活动的疾病、缺乏皮质类固醇节约效应、不良反应（4 名患者）和其他原因（4 名患者）。
在这项研究中，TNF 抑制剂治疗诱导了缓解，包括难治性 TA 患者的持续缓解。然而，33%的患者在接受 TNF 抑制剂治疗时出现疾病复发，20%的患者因不良反应而停止治疗。
