From the *Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung; †School of Medicine, National Yang-Ming University, Taipei; ‡School of Medicine, Chung-Shan Medical University, Taichung; §Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei; ∥Institute of Biomedical Science, National Chung-Hsing University; ¶Department of Medical Research, Taichung Veterans General Hospital, Taichung; #Institute of Hospital and Health Care Administration, National Yang Ming University; and **Department of Education and Research, Taipei City Hospital, Taipei, Taiwan, Republic of China.
J Clin Rheumatol. 2013 Dec;19(8):432-8. doi: 10.1097/RHU.0000000000000041.
The objective of this study was to investigate the association between periodontitis (PD) and etanercept (ETN) discontinuation in anti-tumor necrosis factor (anti-TNF)-naive patients with rheumatoid arthritis (RA).
This retrospective nationwide population-based cohort study identified 3359 anti-TNF-naive patients with RA (age at diagnosis ≥16 years) in whom ETN treatment was initiated using administrative data. We identified PD exposure within 5 years before ETN initiation and during ETN treatment. Cox proportional hazard models were used to assess ETN discontinuation risk associated with PD within 5 years before ETN initiation, shown as hazard ratios with 95% confidence intervals (CIs). Stratified analyses were performed on the basis of PD during ETN treatment to avoid violating the Cox regression assumptions.
Patients with PD history during the 5 years before ENT initiation had a higher risk of ETN discontinuation compared with those without such history; the hazard ratios of ETN discontinuation were 1.27 (95% CI, 1.01-1.60) and 1.17 (95% CI, 1.06-1.30) among patients with and without PD during ETN treatment, respectively. Other risk factors included age older than 65 years and daily prednisolone dose greater than 10 mg/d within 1 year before ETN initiation. Concomitant methotrexate, leflunomide, salazopyrin, or hydroxychloroquine administration had a protective effect on ETN discontinuation in patients without PD during ETN treatment, but the protective effect by leflunomide, salazopyrin, and hydroxychloroquine was attenuated in patients with PD during ETN treatment (P for interaction <0.05).
A PD history within 5 years before ETN administration was associated with increased ETN discontinuation risk in anti-TNF-naive patients with RA.
本研究旨在探讨牙周炎（PD）与依那西普（ETN）在抗肿瘤坏死因子（anti-TNF）初治类风湿关节炎（RA）患者中停药的关系。
本回顾性全国基于人群的队列研究使用行政数据确定了 3359 名抗 TNF 初治 RA（诊断时年龄≥16 岁）患者，其中使用 ETN 治疗。我们确定了 ETN 起始前 5 年内和 ETN 治疗期间的 PD 暴露情况。使用 Cox 比例风险模型评估 ETN 起始前 5 年内 PD 与 ETN 停药风险的相关性，结果以风险比（95%置信区间[CI]）表示。根据 ETN 治疗期间的 PD 进行分层分析，以避免违反 Cox 回归假设。
与无 PD 史患者相比，ETN 起始前 5 年内有 PD 史的患者 ETN 停药风险更高；ETN 治疗期间有 PD 史和无 PD 史的患者 ETN 停药的风险比分别为 1.27（95%CI，1.01-1.60）和 1.17（95%CI，1.06-1.30）。其他风险因素包括年龄大于 65 岁和 ETN 起始前 1 年内每日泼尼松剂量大于 10mg/d。在 ETN 治疗期间无 PD 的患者中，同时使用甲氨蝶呤、来氟米特、柳氮磺胺吡啶或羟氯喹可降低 ETN 停药风险，但在 ETN 治疗期间有 PD 的患者中，来氟米特、柳氮磺胺吡啶和羟氯喹的保护作用减弱（P 交互<0.05）。
ETN 治疗前 5 年内有 PD 史与抗 TNF 初治 RA 患者 ETN 停药风险增加相关。
