Fabbroni Marta, Cantarini Luca, Caso Francesco, Costa Luisa, Pagano Veronica Anna, Frediani Bruno, Manganelli Stefania, Galeazzi Mauro
Rheumatology Unit, Research Center of Systemic Autoimmune and Autoinflammatory Diseases, Policlinico Le Scotte, University of Siena, Viale Bracci 1, 53100 Siena, Italy.
Rheumatology Unit, Research Center of Systemic Autoimmune and Autoinflammatory Diseases, Policlinico Le Scotte, University of Siena, Viale Bracci 1, 53100 Siena, Italy ; Rheumatology Unit, Department of Medicine DIMED, University of Padova, Via Giustiniani 2, 35128 Padova, Italy.
Mediators Inflamm. 2014;2014:862969. doi: 10.1155/2014/862969. Epub 2014 Jul 8.
The study aim was to determine treatment persistence rates and to identify causes of discontinuation in psoriatic arthritis (PsA) and ankylosing spondylitis (AS) patients in clinical practice.
Patients treated with adalimumab (ADA), etanercept (ETA), or infliximab (INF) were retrospectively included. Treatment persistence rates were analyzed by means of a stepwise logistic regression. Differences between therapy duration were assessed by means of an analysis of variance model (ANOVA), while a chi-square test was used to evaluate relationships between therapies and causes of treatment discontinuation and the administration of concomitant disease-modifying antirheumatic drugs (DMARDs) among therapies and types of disease considering completed courses of therapy versus courses that were discontinued.
268 patients received a total of 353 anti-TNF treatment courses (97 ADA, 180 ETA, and 76 INF). Comparison among therapies showed significant difference regarding the treatment persistence rates due to the contrast between ETA and INF (P = 0.0062). We observed that 84.7% of patients were still responding after 6 months of follow-up. Comparison among diseases showed that there were significant differences between PsA and AS (P = 0.0073) and PsA and PsA with predominant axial involvement (P = 0.0467) in terms of duration of the therapy, while there were no significant differences with regard to the persistence rate.
In this cohort, anti-TNF-α therapy was associated with high drug persistence rates. As in rheumatoid arthritis, switching to another anti-TNF-α agent can be an effective option when, during the treatment of AS or PsA, therapy is suspended because of inefficacy or an adverse event. Combination therapy with DMARDs was associated with a better persistence rate.
本研究旨在确定临床实践中银屑病关节炎（PsA）和强直性脊柱炎（AS）患者的治疗持续率，并找出停药原因。
回顾性纳入接受阿达木单抗（ADA）、依那西普（ETA）或英夫利昔单抗（INF）治疗的患者。通过逐步逻辑回归分析治疗持续率。采用方差分析模型（ANOVA）评估治疗持续时间的差异，同时使用卡方检验评估治疗与停药原因之间的关系，以及在考虑完成疗程与中断疗程的情况下，治疗方法与疾病类型之间联合使用改善病情抗风湿药（DMARDs）的情况。
268例患者共接受了353个抗TNF治疗疗程（97个ADA疗程、180个ETA疗程和76个INF疗程）。治疗方法之间的比较显示，由于ETA和INF之间的差异，治疗持续率存在显著差异（P = 0.0062）。我们观察到，84.7%的患者在随访6个月后仍有反应。疾病之间的比较显示，PsA与AS（P = 0.0073）以及PsA与主要累及中轴关节的PsA（P = 0.0467）在治疗持续时间方面存在显著差异，而在持续率方面没有显著差异。
在该队列中，抗TNF-α治疗的药物持续率较高。与类风湿关节炎一样，在AS或PsA治疗期间，若因疗效不佳或不良事件而暂停治疗，换用另一种抗TNF-α药物可能是一种有效的选择。与DMARDs联合治疗的持续率更高。
