肿瘤坏死因子-α抑制剂在强直性脊柱炎和非放射学中轴型脊柱关节炎中的应用：治疗反应、药物留存率及患者预后
Tumor Necrosis Factor-α Inhibition in Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis: Treatment Response, Drug Survival, and Patient Outcome.
作者信息
Corli Justine, Flipo René-Marc, Philippe Peggy, Bera-Louville Anne, Béhal Hélène, Wibaux Cécile, Paccou Julien
机构信息
From the Department of Rheumatology, and Department of Biostatistics, Lille University Hospital, Lille, France.J. Corli, Resident, Department of Rheumatology, Lille University Hospital; R. Flipo, MD, PhD, Department of Rheumatology, Lille University Hospital; P. Philippe, MD, Department of Rheumatology, Lille University Hospital; A. Bera-Louville, MD, Department of Rheumatology, Lille University Hospital; H. Béhal, MSc, Department of Biostatistics, Lille University Hospital; C. Wibaux, MD, Department of Rheumatology, Lille University Hospital; J. Paccou, MD, PhD, Department of Rheumatology, Lille University Hospital.
出版信息
J Rheumatol. 2015 Dec;42(12):2376-82. doi: 10.3899/jrheum.150372. Epub 2015 Nov 15.
OBJECTIVE
The purpose of this study was to (1) evaluate baseline characteristics of nonradiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis (AS) treated with tumor necrosis factor-α inhibitors (TNFi), (2) assess the response to first TNFi treatment, and (3) compare drug-survival duration and rates.
METHODS
Inclusion criteria were patients with axSpA who initiated first TNFi treatment between April 2001 and July 2014 and were followed up for at least 3 months. Efficacy criteria were an improvement of at least 2 points (on a 0-10 scale) or a 50% improvement in the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Baseline characteristics, responses at 12 months, and drug survival were compared between AS and nr-axSpA.
RESULTS
A total of 361 patients were included in the study (AS, n = 263 and nr-axSpA, n = 98). Patients with AS were more often men (65.02% vs 45.92%, p = 0.001) and had longer symptom duration (11.71 ± 9.52 vs 7.34 ± 9.30 yrs, p < 0.001). Median levels of acute-phase reactants (C-reactive protein and erythrocyte sedimentation rate) were significantly higher in patients with AS (p < 0.001 for both). Median BASDAI scores at first TNFi initiation were not higher in patients with nr-axSpA than in patients with AS (59, 49-70 vs 60, 50-70, p = 0.73). BASDAI 20 and BASDAI 50 response rates at 12 months were not statistically different between patients with AS and patients with nr-axSpA (74.58% vs 64.58%, p = 0.19 and 61.02% vs 50.00%, p = 0.19, respectively). No statistically significant difference in terms of survival was observed between patients with AS and nr-axSpA (p = 1.00).
CONCLUSION
Treatment response and drug survival were similar in patients with AS and nr-axSpA after first TNFi initiation.
目的
本研究的目的是（1）评估接受肿瘤坏死因子-α抑制剂（TNFi）治疗的非放射学轴向性脊柱关节炎（nr-axSpA）和强直性脊柱炎（AS）的基线特征，（2）评估首次TNFi治疗的反应，以及（3）比较药物生存时间和比率。
方法
纳入标准为2001年4月至2014年7月开始首次TNFi治疗且随访至少3个月的axSpA患者。疗效标准为巴斯强直性脊柱炎疾病活动指数（BASDAI）至少改善2分（0-10分制）或改善50%。比较AS和nr-axSpA的基线特征、12个月时的反应以及药物生存情况。
结果
本研究共纳入361例患者（AS，n = 263；nr-axSpA，n = 98）。AS患者男性比例更高（65.02%对45.92%，p = 0.001），症状持续时间更长（11.71±9.52对7.34±9.30年，p < 0.001）。AS患者急性期反应物（C反应蛋白和红细胞沉降率）的中位数水平显著更高（两者p均< 0.001）。首次使用TNFi时，nr-axSpA患者的BASDAI中位数评分并不高于AS患者（59，49-70对60，50-70，p = 0.73）。AS患者和nr-axSpA患者在12个月时的BASDAI 20和BASDAI 50反应率无统计学差异（分别为74.58%对64.58%，p = 0.19；61.02%对50.00%，p = 0.19）。AS患者和nr-axSpA患者在生存方面未观察到统计学显著差异（p = 1.00）。
结论
首次使用TNFi后，AS患者和nr-axSpA患者的治疗反应和药物生存情况相似。
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