Nakashima Yasuharu, Kondo Masakazu, Fukuda Takaaki, Harada Hiroshi, Horiuchi Takahiko, Ishinishi Takashi, Jojima Hiroshi, Kuroda Koji, Miyahara Hisaaki, Maekawa Masayuki, Nishizaka Hiroaki, Nagamine Ryuji, Nakashima Hitoshi, Otsuka Takeshi, Shono Eisuke, Suematsu Eiichi, Shimauchi Takashi, Tsuru Tomomi, Wada Ken, Yoshizawa Shigeru, Yoshizawa Seiji, Iwamoto Yukihide
Department of Orthopaedic Surgery, Kyushu University , Fukuoka , Japan.
Mod Rheumatol. 2014 Mar;24(2):258-64. doi: 10.3109/14397595.2013.854069.
This study aimed to evaluate the remission in rheumatoid arthritis (RA) patients treated with tocilizumab (TCZ), based on prospectively registered data in clinical practice.
We studied 114 consecutive RA patients treated with TCZ for an average of 3.5 years. Remission was evaluated by using the EULAR criteria and the new ACR/EULAR Boolean-based criteria.
Among 114 patients (average age 52.2 years; average disease duration 10.6 years), 76 (67 %) had previously received anti-TNF biologics. Mean baseline DAS28-ESR of 5.4 and improved to 2.4 at 36 months. Overall, DAS28-ESR <2.6 was attained by 66.7 %, while ACR/EULAR remission was attained by 35.1 %. ACR/EULAR remission rate was significantly higher in the patients who were biologics-naïve and had good response at the first month. Among 23 patients who completed the treatment for 3 years and had ACR/EULAR remission at 1 year, 15 (65 %) remained in the remission and 16 (70 %) had a DAS28-ESR <2.6 at the final follow-up. The retention rate at 36 months was 68.2 %.
In patients with RA, TCZ is highly effective for both biologics-naïve patients and patients previously exposed to biologics, achieving a high remission rate and drug continuation rate (68.2 %) in clinical practice.
本研究旨在基于临床实践中前瞻性登记的数据，评估接受托珠单抗（TCZ）治疗的类风湿关节炎（RA）患者的缓解情况。
我们研究了114例连续接受TCZ治疗平均3.5年的RA患者。采用欧洲抗风湿病联盟（EULAR）标准和新的基于美国风湿病学会（ACR）/EULAR布尔值的标准评估缓解情况。
在114例患者中（平均年龄52.2岁；平均病程10.6年），76例（67%）曾接受过抗TNF生物制剂治疗。平均基线疾病活动度评分（DAS28）-红细胞沉降率（ESR）为5.4，36个月时改善至2.4。总体而言，66.7%的患者达到DAS28-ESR<2.6，而35.1%的患者达到ACR/EULAR缓解。初治生物制剂且在第一个月有良好反应的患者中，ACR/EULAR缓解率显著更高。在23例完成3年治疗且在1年时达到ACR/EULAR缓解的患者中，15例（65%）仍处于缓解状态，16例（70%）在最后随访时DAS28-ESR<2.6。36个月时的保留率为68.2%。
在RA患者中，TCZ对初治生物制剂患者和既往接触过生物制剂的患者均高度有效，在临床实践中实现了高缓解率和药物持续率（68.2%）。
