肿瘤坏死因子抑制剂治疗与强直性脊柱炎前葡萄膜炎的发生：来自瑞典生物制剂登记处的结果。
Tumour necrosis factor inhibitor treatment and occurrence of anterior uveitis in ankylosing spondylitis: results from the Swedish biologics register.
机构信息
Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
出版信息
Ann Rheum Dis. 2017 Sep;76(9):1515-1521. doi: 10.1136/annrheumdis-2016-210931. Epub 2017 Mar 2.
OBJECTIVES
Tumour necrosis factor-α inhibitor (TNFi) treatment has been shown to reduce the rates of anterior uveitis (AU) in patients with ankylosing spondylitis (AS). Our objective was to compare the effect of adalimumab (ADA), etanercept (ETN) and infliximab (IFX) on AU occurrence in AS, using real-world data.
METHODS
Patients with AS starting ADA, ETN or IFX as their first TNFi from January 2003 to December 2010 were extracted from the Swedish Rheumatology Quality Register. AU rates, based on visits to an ophthalmologist with International Classification of Diseases 10 codes for AU, were obtained by linkage to the Swedish National Patient Register. For each TNFi, AU rates 2 years before TNFi start and for the first 2 years on TNFi treatment were compared. In the subgroup of patients who were AU-free during the 2 years before TNFi start, we also compared the risk of a first AU event.
RESULTS
1365 patients with AS were included (406 ADA, 354 ETN, 605 IFX). Compared with pretreatment rates, we noted a reduction in overall AU rates for ADA and IFX, and an increase for ETN. The adjusted HRs for AU in 1127 patients who were free of AU in the last 2 years before TNFi start were significantly higher for ETN versus ADA (HR: 3.86 95% CI 1.85 to 8.06) and ETN versus IFX (HR: 1.99, 95% CI 1.23 to 3.22), while the HR for IFX versus ADA was not statistically significant.
CONCLUSIONS
The results suggest differences in effect on AU risk between ADA, ETN and IFX, with a clear advantage for ADA/IFX over ETN.
目的
肿瘤坏死因子-α抑制剂（TNFi）治疗已被证明可降低强直性脊柱炎（AS）患者前葡萄膜炎（AU）的发生率。我们的目的是使用真实世界数据比较阿达木单抗（ADA）、依那西普（ETN）和英夫利昔单抗（IFX）对 AS 中 AU 发生的影响。
方法
从 2003 年 1 月至 2010 年 12 月，从瑞典风湿病质量登记处提取开始使用 ADA、ETN 或 IFX 作为其第一种 TNFi 的 AS 患者。通过与瑞典国家患者登记处的链接，获得基于国际疾病分类第 10 版 AU 代码就诊眼科医生的 AU 发生率。对于每种 TNFi，比较 TNFi 开始前 2 年和 TNFi 治疗的头 2 年的 AU 发生率。在 TNFi 开始前 2 年内无 AU 的患者亚组中，我们还比较了首次 AU 事件的风险。
结果
共纳入 1365 例 AS 患者（406 例 ADA、354 例 ETN、605 例 IFX）。与治疗前相比，ADA 和 IFX 的总体 AU 发生率降低，而 ETN 的 AU 发生率增加。在最后 2 年内无 AU 的 1127 例患者中，与 ADA 相比，ETN 发生 AU 的调整 HR 显著更高（HR：3.86 95%CI 1.85 至 8.06）和 ETN 与 IFX（HR：1.99，95%CI 1.23 至 3.22），而 IFX 与 ADA 之间的 HR 无统计学意义。
结论
结果表明 ADA、ETN 和 IFX 对 AU 风险的影响存在差异，ADA/IFX 明显优于 ETN。
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