Rheumatology Research Unit, Instituto de Medicina Molecular, Edificio Egas Moniz, Faculdade de Medicina de Lisboa, Av Egas Moniz, 1649-028 Lisbon, Portugal.
Rheumatology (Oxford). 2012 Nov;51(11):2020-6. doi: 10.1093/rheumatology/kes184. Epub 2012 Jul 28.
Adalimumab, etanercept and infliximab are effective TNF inhibitors (TNFis) in the treatment of RA, but no randomized clinical trials have compared the three agents. Prior observational data are not consistent. We compared their effectiveness over 1 year in a prospective cohort.
Analyses were performed on subjects' first episode of TNFi use in the Rheumatic Diseases Portuguese Register, Reuma.pt. The primary outcome was the proportion of patients with European League Against Rheumatism good response sustained at two consecutive observations separated by 3 months during the first year of TNFi use. Comparisons were performed using conventional adjusted logistic regression, as well as matching subjects across the three agents using a propensity score. In addition, baseline predictors of treatment response to TNFi were identified.
The study cohort included 617 RA patients, 250 starting etanercept, 206 infliximab and 161 adalimumab. Good response was achieved by 59.6% for adalimumab, 59.2% for etanercept and 51.9% for infliximab (P = 0.21). The modelled probability of good response did not significantly differ across agents (etanercept vs adalimumab OR = 0.97, 95% CI 0.55, 1.71; etanercept vs infliximab OR = 1.25, 95% CI 0.74, 2.12; infliximab vs adalimumab OR = 0.80, 95% CI 0.47, 1.36). Matched propensity score analyses also showed no significant treatment response differences. Greater educational attainment was a predictor of better response, while smoking, presence of ACPA, glucocorticoid use and worse physician assessment of disease activity at baseline each predicted a reduced likelihood of treatment response.
Over 1 year, we found no difference in effectiveness between adalimumab, etanercept and infliximab.
阿达木单抗、依那西普和英夫利昔单抗是治疗类风湿关节炎（RA）的有效肿瘤坏死因子抑制剂（TNFis），但尚无随机临床试验比较这三种药物。先前的观察性数据并不一致。我们在一个前瞻性队列中比较了它们在一年内的有效性。
在葡萄牙风湿病登记处 Reuma.pt 中，对患者首次使用 TNFi 的情况进行了分析。主要结局是在 TNFi 使用的第一年中，连续两次观察（间隔 3 个月）时，达到欧洲抗风湿病联盟良好反应的患者比例。使用传统的调整后的逻辑回归以及通过倾向评分在三种药物之间匹配受试者进行了比较。此外，还确定了 TNFi 治疗反应的基线预测因素。
研究队列包括 617 例 RA 患者，其中 250 例开始使用依那西普，206 例使用英夫利昔单抗，161 例使用阿达木单抗。阿达木单抗的良好反应率为 59.6%，依那西普为 59.2%，英夫利昔单抗为 51.9%（P=0.21）。模型预测的良好反应概率在不同药物之间没有显著差异（依那西普与阿达木单抗 OR=0.97，95%CI 0.55，1.71；依那西普与英夫利昔单抗 OR=1.25，95%CI 0.74，2.12；英夫利昔单抗与阿达木单抗 OR=0.80，95%CI 0.47，1.36）。匹配倾向评分分析也未显示治疗反应存在显著差异。较高的教育程度是更好反应的预测因素，而吸烟、存在 ACPA、使用糖皮质激素和基线时医生对疾病活动的评估较差，均预测治疗反应的可能性降低。
在 1 年的时间里，我们没有发现阿达木单抗、依那西普和英夫利昔单抗之间在疗效上存在差异。
