切换治疗白塞病的抗 TNF-α 药物。

Switching of anti-TNF-α agents in Behçet's disease.

机构信息

Lupus and Vasculitis Clinic, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge CB2 2QQ, UK.

出版信息

Clin Exp Rheumatol. 2012 May-Jun;30(3 Suppl 72):S62-8. Epub 2012 Sep 27.

Abstract

OBJECTIVES

Recent reports suggest efficacy of anti-tumour necrosis factor-alpha (TNF-α) therapy in Behçet's disease. However, the switching of anti-TNF-α agents for treatment failure remains unexplored. Our aims were to describe the efficacy and safety of a second anti-TNF-α agent in Behçet's disease patients after failure of a first agent.

METHODS

In this retrospective case series, 34 Behçet's disease patients receiving anti-TNF-α agents, 19 of whom switched to a second anti-TNF-α agent, were identified. We assessed the response to anti-TNF-α agents, the duration of anti-TNF-α therapy, the reasons for withdrawal, adverse events, the Behçet's Disease Current Activity Form (BDCAF), C-reactive protein (CRP), ESR and concomitant therapies at the onset of the first and second anti-TNF-α therapies, and after 6, 12 and 24 months.

RESULTS

Clinical improvements were seen in 26/34 (76%) after the first and 18/19 (95%) after the second anti-TNF-α agent. Continuation rates at 24 months were 14.4% after the first and 22.3% after the second anti-TNF-α agent. The most frequent reason for discontinuation was secondary failure in both groups (12 after the first anti-TNF-α agent and 8 after the second). Adverse events leading to treatment withdrawal were seen in 10 after the first anti-TNF-α agent and three after the second.

CONCLUSIONS

[corrected] The second anti-TNF-α agent in Behçet's disease demonstrated similar efficacy to that seen with the first agent without new safety concerns, supporting switching to a second anti-TNF-α agent. However, long-term continuation rates for anti-TNF-α therapy were low after both the first and second agents.

摘要

目的

最近的报告表明，肿瘤坏死因子-α（TNF-α）拮抗剂在白塞病中的疗效。然而，对于治疗失败后抗 TNF-α 药物的转换仍未得到探索。我们的目的是描述白塞病患者在第一种抗 TNF-α 药物治疗失败后使用第二种抗 TNF-α 药物的疗效和安全性。

方法

在这项回顾性病例系列研究中，确定了 34 名接受抗 TNF-α 药物治疗的白塞病患者，其中 19 名患者转换为第二种抗 TNF-α 药物。我们评估了抗 TNF-α 药物的反应、抗 TNF-α 治疗的持续时间、停药的原因、不良事件、白塞病活动指数（BDCAF）、C 反应蛋白（CRP）、红细胞沉降率（ESR）和伴随治疗在开始使用第一种和第二种抗 TNF-α 药物时以及使用后 6、12 和 24 个月时的情况。

结果

第一种抗 TNF-α 药物治疗后，26/34（76%）例患者临床改善，第二种抗 TNF-α 药物治疗后 18/19（95%）例患者临床改善。24 个月时的继续治疗率为第一种抗 TNF-α 药物治疗后 14.4%，第二种抗 TNF-α 药物治疗后 22.3%。两组中最常见的停药原因是继发失效（第一种抗 TNF-α 药物治疗后 12 例，第二种抗 TNF-α 药物治疗后 8 例）。第一种抗 TNF-α 药物治疗后出现 10 例不良事件导致停药，第二种抗 TNF-α 药物治疗后出现 3 例不良事件导致停药。