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体重并不影响类风湿关节炎患者对静脉注射阿巴西普的临床反应。来自“阿巴西普全欧洲注册协作组(PANABA)”的分析。

Body mass does not impact the clinical response to intravenous abatacept in patients with rheumatoid arthritis. Analysis from the "pan-European registry collaboration for abatacept (PANABA).

作者信息

Iannone Florenzo, Courvoisier Delphine S, Gottenberg Jacques Eric, Hernandez Maria Victoria, Lie Elisabeth, Canhão Helena, Pavelka Karel, Hetland Merete Lund, Turesson Carl, Mariette Xavier, Choquette Denis, Finckh Axel

机构信息

Department of Emergency and Organ Trasplantation-Rheumatology Unit, University of Bari, Policlinico, Piazza G. Cesare 11, 70124, Bari, Italy.

University Hospital, Geneva, Switzerland.

出版信息

Clin Rheumatol. 2017 Apr;36(4):773-779. doi: 10.1007/s10067-016-3505-5. Epub 2016 Dec 14.

Abstract

Some evidences suggest that obesity impairs the effectiveness of TNF inhibitors. We examined the impact of body mass index (BMI) on the clinical effectiveness of abatacept in rheumatoid arthritis (RA) patients. This is a pooled analysis of 10 prospective cohorts of RA patients. All patients with available BMI were included in this study. The primary endpoint was drug retention of abatacept in the different BMI categories. Multivariable Cox regression was used to estimate hazard ratios (HRs) for drug discontinuation. A secondary endpoint was EULAR/LUNDEX response rates at 6/12 months. Of the 2015 RA patients initiating therapy with IV abatacept, 380 (18.9%) were classified as obese. Obese patients had more functional disability, and were less often RF positive. The median abatacept retention time was 1.91 years for obese RA patients compared to 2.12 years for non-obese patients (p = 0.15). The risk of abatacept discontinuation was not significantly different for overweight (HR 1.03 (95% CI 0.89-1.19)), or for obese (HR 1.08 (95% CI 0.89-1.30)) compared to normal-weight patients. Rheumatoid factor positivity reduced the risk of abatacept discontinuation (HR 0.83 (95% CI 0.72-0.95)), while previous biologic therapy was positively associated with drug interruption (HRs increasing from 1.68 to 2.16 with the line of treatments). Obese and non-obese patients attained similar rates of EULAR/LUNDEX clinical response at 6/12 months. Drug retention and clinical response rates to abatacept do not seem to be decreased by obesity in RA patients.

摘要

一些证据表明肥胖会削弱肿瘤坏死因子抑制剂的疗效。我们研究了体重指数(BMI)对类风湿关节炎(RA)患者使用阿巴西普临床疗效的影响。这是一项对10个RA患者前瞻性队列的汇总分析。所有有可用BMI数据的患者均纳入本研究。主要终点是不同BMI类别中阿巴西普的药物保留率。采用多变量Cox回归估计停药的风险比(HR)。次要终点是6/12个月时的欧洲抗风湿病联盟(EULAR)/LUNDEX反应率。在2015例开始接受静脉注射阿巴西普治疗的RA患者中,380例(18.9%)被归类为肥胖。肥胖患者功能残疾更多,类风湿因子(RF)阳性率更低。肥胖RA患者阿巴西普的中位保留时间为1.91年,而非肥胖患者为2.12年(p = 0.15)。与正常体重患者相比,超重(HR 1.03(95%CI 0.89 - 1.19))或肥胖(HR 1.08(95%CI 0.89 - 1.30))患者停用阿巴西普的风险无显著差异。类风湿因子阳性降低了阿巴西普停药的风险(HR 0.83(95%CI 0.72 - 0.95)),而既往生物治疗与药物中断呈正相关(随着治疗线数增加,HR从1.68增至2.16)。肥胖和非肥胖患者在6/12个月时达到相似的EULAR/LUNDEX临床反应率。RA患者的肥胖似乎并未降低阿巴西普的药物保留率和临床反应率。

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