Carmel Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
J Rheumatol. 2013 Jan;40(1):16-22. doi: 10.3899/jrheum.111516. Epub 2012 Oct 15.
To assess the association between treatment with anti-tumor necrosis factor-α (TNF-α) agents and the occurrence of hospitalizations, their causes and complications, compared to treatment with traditional disease-modifying antirheumatic drugs in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS).
A retrospective cohort study was conducted of patients with RA, AS, and PsA treated with anti-TNF-α agents between April 2002 and December 2007. Patients were assessed during the period of anti-TNF-α treatment (Group B) and compared to an equivalent period before initiation of anti-TNF-α therapy (Group A). All hospitalization charts were reviewed and diagnoses, comorbidities, concomitant medications, and clinical course were analyzed. Statistical analysis was performed using multivariate mixed Poisson regression.
In the study period of 57 months, 735 hospitalization events of 327 patients were analyzed. Statistically significant decreases were seen in the total number of hospitalization events as well as hospitalizations due to exacerbation of rheumatic diseases in Group B compared to Group A (44.4 vs 74.2 and 21.9 vs 47.5 per 100 patient-years, respectively; p < 0.0001). More infectious events (7.4 in Group B compared to 4.6 per 100 patient-years in Group A; p = 0.043) were associated with anti-TNF-α treatment, older age, and underlying disease, because patients with RA had higher rates of infections compared to patients with PsA and patients with AS.
The overall effect of anti-TNF-α therapy was a significant decline in total hospitalization events. The decrease was more prominent in patients with RA than in patients with AS and patients with PsA, and reflected the significant decrease in hospitalizations due to rheumatic disease exacerbation. The decrease was more pronounced than the observed increase in infectious events.
评估与传统疾病修饰抗风湿药物相比，肿瘤坏死因子-α（TNF-α）拮抗剂治疗类风湿关节炎（RA）、银屑病关节炎（PsA）和强直性脊柱炎（AS）患者的住院情况、住院原因和并发症。
对 2002 年 4 月至 2007 年 12 月期间接受 TNF-α拮抗剂治疗的 RA、AS 和 PsA 患者进行回顾性队列研究。在 TNF-α 治疗期间（B 组）对患者进行评估，并与开始 TNF-α 治疗前的等效时期（A 组）进行比较。所有住院病历均进行了回顾，分析了诊断、合并症、合并用药和临床病程。采用多变量混合泊松回归进行统计分析。
在 57 个月的研究期间，对 327 名患者的 735 例住院事件进行了分析。与 A 组相比，B 组的总住院事件数以及风湿性疾病恶化所致住院数均显著减少（分别为 44.4 比 74.2 和 21.9 比 47.5/100 患者年；p < 0.0001）。B 组的感染事件（7.4 比 A 组的 4.6/100 患者年；p = 0.043）更多，与 TNF-α 治疗、年龄较大和基础疾病有关，因为与 PsA 和 AS 患者相比，RA 患者的感染率更高。
TNF-α 治疗的总体效果是总住院事件显著减少。RA 患者的降幅比 AS 和 PsA 患者更明显，反映了风湿性疾病恶化所致住院的显著减少。这种减少比观察到的感染事件增加更为显著。
