Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
Clin Rheumatol. 2013 Feb;32(2):253-9. doi: 10.1007/s10067-012-2118-x. Epub 2012 Nov 21.
The present study retrospectively assessed the efficacy of tocilizumab in patients with rheumatoid arthritis (RA) who failed to respond to treatment with etanercept or infliximab. A retrospective study of 33 RA patients who did not respond to etanercept or infliximab was conducted. Responses of subjects switching from etanercept to tocilizumab (n = 17) were compared with those switching from infliximab to tocilizumab (n = 16). Treatment with disease-modifying antirheumatic drugs before the switch, especially methotrexate (MTX), was maintained. Disease activity was assessed by the Disease Activity Score 28-C Reactive Protein (DAS28-CRP), the Simplified Disease Activity Index (SDAI), and the Clinical Disease Activity Index (CDAI). Patients who switched from etanercept were significantly less likely to have used MTX and were significantly older than patients who switched from infliximab. In both groups, there was a significant reduction from baseline in DAS28-CRP, SDAI, and CDAI values at 24 weeks with no significant differences between groups. However, at week 52, DAS28-CRP, SDAI, and CDAI values in the group switched from etanercept were significantly worse than those in the group switched from infliximab. All patients switched from infliximab were using MTX. In the evaluation between patients who switched from etanercept monotherapy, etanercept plus MTX, and infliximab plus MTX, a significant improvement from baseline was seen in DAS28-CRP, SDAI, and CDAI for all patients at 24 weeks with no significant differences between groups. Disease activity was maintained at 52 weeks in the group that switched from etanercept plus MTX and infliximab plus MTX. However, the efficacy of tocilizumab was decreased in the group that switched from etanercept monotherapy. Switching from etanercept plus MTX or from infliximab plus MTX to tocilizumab plus MTX improved response to therapy, but switching from etanercept monotherapy to tocilizumab monotherapy did not improve response to therapy.
本研究回顾性评估了托珠单抗在对依那西普或英夫利昔单抗治疗反应不佳的类风湿关节炎（RA）患者中的疗效。对 33 例对依那西普或英夫利昔单抗无反应的 RA 患者进行了回顾性研究。比较了从依那西普转换为托珠单抗（n=17）的受试者的反应与从英夫利昔单抗转换为托珠单抗（n=16）的受试者的反应。转换前使用的疾病修饰抗风湿药物（DMARDs），特别是甲氨蝶呤（MTX），得到维持。疾病活动度通过 28 个关节疾病活动度评分（DAS28-CRP）、简化疾病活动指数（SDAI）和临床疾病活动指数（CDAI）进行评估。从依那西普转换的患者使用 MTX 的可能性显著降低，且年龄显著大于从英夫利昔单抗转换的患者。两组患者在 24 周时 DAS28-CRP、SDAI 和 CDAI 值均较基线显著降低，两组间无显著差异。然而，在第 52 周时，从依那西普转换的患者 DAS28-CRP、SDAI 和 CDAI 值显著差于从英夫利昔单抗转换的患者。所有从英夫利昔单抗转换的患者均使用 MTX。在从依那西普单药、依那西普加 MTX 和英夫利昔单抗加 MTX 转换的患者之间的评估中，所有患者在 24 周时 DAS28-CRP、SDAI 和 CDAI 值均较基线显著改善，且两组间无显著差异。从依那西普加 MTX 和英夫利昔单抗加 MTX 转换的患者在第 52 周时疾病活动度得以维持。然而，从依那西普单药转换为托珠单抗单药后，托珠单抗的疗效下降。从依那西普加 MTX 或英夫利昔单抗加 MTX 转换为托珠单抗加 MTX 可改善治疗反应，但从依那西普单药转换为托珠单抗单药不能改善治疗反应。
