在临床实践中，托珠单抗可减少类风湿关节炎患者的皮质类固醇用量。
Tocilizumab induces corticosteroid sparing in rheumatoid arthritis patients in clinical practice.
作者信息
Fortunet Clémentine, Pers Yves-Marie, Lambert Joseph, Godfrin-Valnet Marie, Constant Elodie, Devilliers Hervé, Gaudin Philippe, Jorgensen Christian, Prades Béatrice Pallot, Wendling Daniel, Maillefert Jean Francis
机构信息
Department of Rheumatology, Dijon University Hospital, INSERM U1093, UFR Médecine, University of Burgundy, Dijon, Clinical Immunology and Osteoarticular Diseases Therapeutic Unit, Lapeyronie University Hospital, Montpellier, Department of Rheumatology, Grenoble University Hospital, Grenoble, Department of Rheumatology, Besançon University Hospital, Besançon, Department of Rheumatology, Saint Etienne University Hospital, Saint Etienne and Department of Internal Medicine and Systemic Disease Unit, Dijon University Hospital, Dijon, France. Department of Rheumatology, Dijon University Hospital, INSERM U1093, UFR Médecine, University of Burgundy, Dijon, Clinical Immunology and Osteoarticular Diseases Therapeutic Unit, Lapeyronie University Hospital, Montpellier, Department of Rheumatology, Grenoble University Hospital, Grenoble, Department of Rheumatology, Besançon University Hospital, Besançon, Department of Rheumatology, Saint Etienne University Hospital, Saint Etienne and Department of Internal Medicine and Systemic Disease Unit, Dijon University Hospital, Dijon, France.
Department of Rheumatology, Dijon University Hospital, INSERM U1093, UFR Médecine, University of Burgundy, Dijon, Clinical Immunology and Osteoarticular Diseases Therapeutic Unit, Lapeyronie University Hospital, Montpellier, Department of Rheumatology, Grenoble University Hospital, Grenoble, Department of Rheumatology, Besançon University Hospital, Besançon, Department of Rheumatology, Saint Etienne University Hospital, Saint Etienne and Department of Internal Medicine and Systemic Disease Unit, Dijon University Hospital, Dijon, France.
出版信息
Rheumatology (Oxford). 2015 Apr;54(4):672-7. doi: 10.1093/rheumatology/keu339. Epub 2014 Sep 22.
OBJECTIVE
. The aim of this study was to evaluate the impact of introducing tocilizumab (TCZ) as co-therapy with CS in patients with RA.
METHODS
This study was an open, observational, retrospective multicentre study. RA patients treated with oral CS for >3 months who started treatment with TCZ between December 2009 and June 2011 in five centres were included. Variables included demographic data, disease history, co-treatments, disease activity and dose of CS at inclusion and at weeks 4, 8, 12 and 24. The evolution of disease activity and of the dose of CS (analysis of variance with repeated measures) were analysed, searching for factors correlated with changes in the dose of CS.
RESULTS
Inclusion of 130 patients [women 80.8%, mean age 56.7 years (s.d. 14.0), RA duration 16.3 years (s.d. 10.4), mean baseline 28-joint DAS (DAS28) 5.1 (s.d. 1.4), mean baseline dose of CS 10.0 mg/day (s.d. 8.2) prednisone equivalent. Decreases in the mean daily dose of CS and in the DAS28 were observed during follow-up [respectively 6.5 mg (s.d. 4.8) at week 24 (P < 0.0001) and 3.0 mg (s.d. 1.4) at week 24 (P < 0.0001)]. The only variable that correlated with the decrease in the dose of CS was the initial dose of the drug (r = 0.82, P < 0.001).
CONCLUSION
The introduction of TCZ led to rapid and long-lasting CS sparing that did not correlate with the reduction in disease activity. It is possible that in patients treated with high-dose CS, the main objective of the clinician is to reduce dosage of CS rather than RA activity.
目的
本研究旨在评估将托珠单抗（TCZ）与糖皮质激素（CS）联合用于类风湿关节炎（RA）患者的疗效。
方法
本研究为开放性、观察性、回顾性多中心研究。纳入2009年12月至2011年6月期间在五个中心开始使用TCZ治疗且口服CS治疗超过3个月的RA患者。变量包括人口统计学数据、疾病史、联合治疗、疾病活动度以及纳入时、第4、8、12和24周时的CS剂量。分析疾病活动度和CS剂量的变化（重复测量方差分析），寻找与CS剂量变化相关的因素。
结果
纳入130例患者[女性占80.8%，平均年龄56.7岁（标准差14.0），RA病程16.3年（标准差10.4），平均基线28关节疾病活动评分（DAS28）为5.1（标准差1.4），平均基线CS剂量为10.0 mg/天（标准差8.2）泼尼松等效剂量]。随访期间观察到CS的平均日剂量和DAS28均降低[分别在第24周时降低6.5 mg（标准差4.8）（P < 0.0001）和在第24周时降低3.0 mg（标准差1.4）（P < 0.0001）]。与CS剂量降低相关的唯一变量是药物初始剂量（r = 0.82，P < 0.001）。
结论
引入TCZ可快速且持久地减少CS用量，且这与疾病活动度的降低无关。对于接受高剂量CS治疗的患者，临床医生的主要目标可能是减少CS用量而非RA活动度。
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