Pharmacy Department, Gregorio Marañón University General Hospital, Madrid, Spain.
J Pharm Pharm Sci. 2012;15(3):355-60. doi: 10.18433/j33w30.
To evaluate the association between starting early treatment with anti-TNF and effectiveness as well as the possibility of applying therapeutic spacing in daily practice in patients with rheumatoid arthritis (RA).
Observational, retrospective study conducted in two universitary hospitals in Spain. RA patients who received the first anti-TNF (adalimumab: ADA, etanercept: ETN or infliximab: IFX) during the study period (October 2006-2010) were included. Demographic data, time since diagnosis, disease activity (DAS28-ESR) and anti-TNF dosage were analyzed. Therapeutic objective was defined as DAS28 DAS28 < 2.6. Also the response related to criteria of the European League Against Rheumatism (EULAR) was evaluated. Therapeutic spacing was defined as the use of a lower dose or a higher interval according to label doses. The main endpoint was to assess the association between the effectiveness and the moment when the anti-TNF therapy begins. The secondary target was to evaluate the association between RA activity at the beginning of treatment with anti-TNF and dose used. Results. 82 patients were included. The prescription profile was: ADA (48.8%), ETN (31.7%) and IFX (19.5%). 71.4% of patients treated with anti-TNF during the first year since diagnosis, 57.1% of those who started after 1-5 years and 30.6% of patients who started after 5 years were in remission when the study ended. De-escalation strategy was performed in 25.6% of patients: ETN (38.5%), ADA (20.0%) and IFX (18.8%). The patients treated with a higher dose according to label doses were: IFX (81%), ADA, (12.5%) and ETN (7.7%).
Results suggest that early treatment with anti-TNF can achieve a higher percentage of remissions. Therapeutic spacing is established as a strategy that improves the efficiency in those patients in remission, being the ETN the anti-TNF most susceptible for spacing, although a relation between the early beginning with anti-TNF and the used dose was not found.
评估类风湿关节炎（RA）患者早期开始使用抗 TNF 治疗的效果及在日常实践中进行治疗间隔的可能性。
本研究为在西班牙两所大学医院进行的观察性、回顾性研究。纳入了在研究期间（2006 年 10 月至 2010 年）接受首次抗 TNF（阿达木单抗：ADA、依那西普：ETN 或英夫利昔单抗：IFX）治疗的 RA 患者。分析了患者的人口统计学数据、诊断后时间、疾病活动度（DAS28-ESR）和抗 TNF 剂量。治疗目标定义为 DAS28＜2.6。还评估了与欧洲抗风湿病联盟（EULAR）标准相关的反应。治疗间隔定义为根据标签剂量使用较低剂量或较高间隔。主要终点是评估抗 TNF 治疗开始时间与疗效之间的关系。次要目标是评估抗 TNF 治疗开始时 RA 活动度与剂量使用之间的关系。结果：共纳入 82 例患者。处方模式为：ADA（48.8%）、ETN（31.7%）和 IFX（19.5%）。71.4%的患者在诊断后 1 年内开始接受抗 TNF 治疗，57.1%的患者在 1-5 年内开始治疗，30.6%的患者在 5 年后开始治疗时达到缓解。25.6%的患者采用了降级策略：ETN（38.5%）、ADA（20.0%）和 IFX（18.8%）。根据标签剂量使用较高剂量的患者为：IFX（81%）、ADA（12.5%）和 ETN（7.7%）。
结果表明，早期使用抗 TNF 治疗可提高缓解率。治疗间隔被确立为一种策略，可以提高缓解患者的治疗效果，依那西普是最适合间隔治疗的抗 TNF，尽管未发现抗 TNF 早期开始与使用剂量之间存在关系。
