Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Australia.
Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Australia; Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Australia.
Semin Arthritis Rheum. 2018 Feb;47(4):478-484. doi: 10.1016/j.semarthrit.2017.08.001. Epub 2017 Aug 3.
To evaluate the impact of treatment with disease-modifying antirheumatic drugs (DMARDs), including IL-6 receptor inhibitor tocilizumab (TCZ), on anaemia markers in patients with rheumatoid arthritis.
Using the Centricity Electronic Medical Records from USA, patients with rheumatoid arthritis diagnosed between January 2000 and April 2016, who initiated TCZ (n = 3732); tofacitinib (TOFA, n = 3126); other biologic DMARD (obDMARD, n = 55,964); or other non-biologic DMARD (onbDMARD, n = 91,236) were identified. Changes in haemoglobin (Hb) and haematocrit (Hct) over 2 years of treatment initiation were evaluated, adjusting and balancing for confounders.
Mean (95% CI) adjusted increase in Hb and Hct levels at 24 months in TCZ group were 0.23g/dL (0.14, 0.42) and 0.96% (0.41, 1.52) respectively. Among patients with anaemia in the TCZ group, Hb and Hct increased significantly by 0.72g/dL and 2.06%, respectively. Patients in the TCZ group were 86% (95% CI of OR: 1.43, 2.00) more likely to increase Hb ≥ 1g/dL compared to the other groups combined. No clinically significant changes in Hb were observed in the other groups. The obDMARD group demonstrated lower Hct increase than TCZ group, while no significant changes were observed in the remaining groups. Compared to those who initiated TCZ therapy after 1 year of diagnosis of rheumatoid arthritis, those who initiated earlier were 95% (OR = 1.95; 95% CI: 1.19, 3.21; p < 0.001) more likely to increase Hb within 6 months.
This real-world study suggests significant increase in Hb and Hct levels after TCZ therapy in anaemic and non-anaemic patients with rheumatoid arthritis, compared with other biologic and non-biologic DMARDs.
评估包括白细胞介素 6 受体抑制剂托珠单抗（TCZ）在内的疾病修饰抗风湿药物（DMARDs）治疗对类风湿关节炎患者贫血标志物的影响。
使用美国 Centricity 电子病历，确定了 2000 年 1 月至 2016 年 4 月期间诊断为类风湿关节炎、开始使用 TCZ（n=3732）、托法替布（TOFA，n=3126）、其他生物 DMARD（obDMARD，n=55964）或其他非生物 DMARD（onbDMARD，n=91236）的患者。评估治疗开始后 2 年内血红蛋白（Hb）和血细胞比容（Hct）的变化，并对混杂因素进行调整和平衡。
TCZ 组 24 个月时 Hb 和 Hct 水平的平均（95%CI）调整后增加值分别为 0.23g/dL（0.14，0.42）和 0.96%（0.41，1.52）。TCZ 组中贫血患者的 Hb 和 Hct 分别显著增加 0.72g/dL 和 2.06%。与其他组相比，TCZ 组患者 Hb 增加≥1g/dL 的可能性高 86%（95%置信区间的 OR：1.43，2.00）。其他组中未观察到 Hb 有临床意义的变化。obDMARD 组的 Hct 增加低于 TCZ 组，而其余组无明显变化。与那些在诊断类风湿关节炎后 1 年才开始 TCZ 治疗的患者相比，那些更早开始治疗的患者在 6 个月内增加 Hb 的可能性高 95%（OR=1.95；95%CI：1.19，3.21；p<0.001）。
这项真实世界的研究表明，与其他生物和非生物 DMARD 相比，TCZ 治疗可使贫血和非贫血类风湿关节炎患者的 Hb 和 Hct 水平显著升高。
