Soubrier Martin, Pereira Bruno, Frayssac Thomas, Fan Angelique, Couderc Marion, Malochet-Guinamand Sandrine, Mathieu Sylvain, Tatar Zuzana, Tournadre Anne, Dubost Jean-Jacques
Rheumatology Department, Chu Hôpital Gabriel Montpied, Clermont-Ferrand, France.
Biostatistics Unit (DRCI), Chu Hôpital Gabriel Montpied, Clermont-Ferrand, France.
Int J Rheum Dis. 2018 Nov;21(11):1924-1932. doi: 10.1111/1756-185X.13156. Epub 2017 Sep 13.
To compare, in real-life conditions, the retention rates of anti-tumor necrosis factor (anti-TNF) treatment (etanercept [ETN], adalimumab [ADA] and infliximab [IFX]) initiated as first-line biotherapy for rheumatoid arthritis (RA) and to evaluate, in case of failure, the switch to another anti-TNF or a non-anti-TNF biological.
Monocentric retrospective cohort including all patients with RA starting a first anti-TNF between 2001 and 2015.
Among the 346 patients analyzed, 201 received ETN, 82 ADA and 63 IFX. The first anti-TNF was interrupted in 151 cases. The retention rates were 82.8%, 67.6%, 46.5%, 28.1% and 22.5% at 1, 2, 5, 10 and 15 years, respectively, with a median retention duration of 52.8 (18.9-136.2) months (ETN: 59.3 [19.1-NA), ADA: 79.9 [19.3-136.2] and IFX: 37.2 [17.5-134.5], P = 0.49). The predictive factors of discontinuation were active RA (Disease Activity Score of 28 joints - C-reactive protein [DAS28-CRP] hazards ratio [HR]: 1.22 [1.03-1.45]), inflammatory syndrome (erythrocyte sedimentation rate HR: 1.01 [1.0-1.02]; CRP HR: 1.00 [1.00-1.01]), absence of methotrexate treatment (HR: 0.60 [0.43-0.83]), and corticosteroid use (HR: 1.91 [1.31-2.78]). The patients who switched to another anti-TNF treatment had an inferior retention than those who switched to a non-anti-TNF treatment (HR: 0.39 [0.17-0.87], P = 0.02).
In real life, there was no difference in retention among the three anti-TNF agents, and 25% of patients continued them at 15 years. After failure of an anti-TNF, the switch to a non-anti-TNF biotherapy showed better retention.
在实际临床环境中，比较作为类风湿关节炎（RA）一线生物治疗起始使用的抗肿瘤坏死因子（抗TNF）治疗（依那西普[ETN]、阿达木单抗[ADA]和英夫利昔单抗[IFX]）的保留率，并在治疗失败时评估换用另一种抗TNF药物或非抗TNF生物制剂的情况。
单中心回顾性队列研究，纳入2001年至2015年间开始首次使用抗TNF治疗的所有RA患者。
在分析的346例患者中，201例接受ETN治疗，82例接受ADA治疗，63例接受IFX治疗。151例患者中断了首次抗TNF治疗。1年、2年、5年、10年和15年时的保留率分别为82.8%、67.6%、46.5%、28.1%和22.5%，中位保留时间为52.8（18.9 - 136.2）个月（ETN：59.3 [19.1 - 无上限]，ADA：79.9 [19.3 - 136.2]，IFX：37.2 [17.5 - 134.5]，P = 0.49）。停药的预测因素包括活动性RA（28个关节疾病活动评分 - C反应蛋白[DAS28-CRP]风险比[HR]：1.22 [1.03 - 1.45]）、炎症综合征（红细胞沉降率HR：1.01 [1.0 - 1.02]；CRP HR：1.00 [1.00 - 1.01]）、未使用甲氨蝶呤治疗（HR：0.60 [0.43 - 0.83]）以及使用皮质类固醇（HR：1.91 [1.31 - 2.78]）。换用另一种抗TNF治疗的患者保留率低于换用非抗TNF治疗的患者（HR：0.39 [0.17 - 0.87]，P = 0.02）。
在实际临床中，三种抗TNF药物的保留率无差异，25%的患者在15年时仍继续使用。抗TNF治疗失败后，换用非抗TNF生物治疗的保留率更高。
