Kobayashi Daisuke, Ito Satoshi, Takai Chinatsu, Hasegawa Eriko, Nomura Yumi, Otani Hiroshi, Abe Asami, Ishikawa Hajime, Murasawa Akira, Narita Ichiei, Nakazono Kiyoshi
a Department of Rheumatology , Niigata Rheumatic Center , Niigata , Japan.
b Division of Clinical Nephrology and Rheumatology , Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan.
Mod Rheumatol. 2018 Jul;28(4):599-605. doi: 10.1080/14397595.2017.1380250. Epub 2017 Oct 3.
The intensification of infliximab (IFX) treatment, involving escalation of the dose and shortening of interval, was approved in Japan in July 2009. We consider IFX intensification therapy to be preferable for patients with treatment-resistant active rheumatoid arthritis (RA). We retrospectively compared the efficacy of IFX with that of other bDMARDs in methotrexate (MTX)-resistant patients.
Patients who satisfied the following criteria were enrolled: (i) those who started bDMARDs between February 2011 and December 2016, and (ii) those who required bDMARDs after 180 d of MTX treatment. We compared 33 patients who had been treated with IFX (IFX group) and 146 who had received other bDMARDs treatment (non-IFX group).
IFX was administered at a dose of 6.98 mg/kg/8-week equivalent at 52 weeks. Clinical disease activity index clinical remission (CDAI-CR) was achieved in 49 of the 179 patients at 52 weeks and 13 of these 49 patients received IFX. Logistic regression analysis showed that treatment with IFX was an important variable for the achievement of CDAI-CR at 52 weeks (odds ratio 2.69, 95% confidence interval 1.13-6.42). The severity and frequency of adverse events did not differ.
Intensification of IFX was effective and well tolerated for MTX resistant patients.
英夫利昔单抗(IFX)强化治疗,包括增加剂量和缩短给药间隔,于2009年7月在日本获批。我们认为IFX强化治疗对于难治性活动性类风湿关节炎(RA)患者更为可取。我们回顾性比较了IFX与其他生物改善病情抗风湿药(bDMARDs)在甲氨蝶呤(MTX)抵抗患者中的疗效。
纳入符合以下标准的患者:(i)2011年2月至2016年12月开始使用bDMARDs的患者,以及(ii)MTX治疗180天后需要使用bDMARDs的患者。我们比较了33例接受IFX治疗的患者(IFX组)和146例接受其他bDMARDs治疗的患者(非IFX组)。
在第52周时,IFX的给药剂量相当于6.98mg/kg/8周。179例患者中有49例在第52周达到临床疾病活动指数临床缓解(CDAI-CR),其中13例接受了IFX治疗。逻辑回归分析表明,IFX治疗是第52周实现CDAI-CR的重要变量(优势比2.69,95%置信区间1.13-6.42)。不良事件的严重程度和发生率没有差异。
IFX强化治疗对MTX抵抗患者有效且耐受性良好。