Department of Rheumatology, Saint-Philibert Hospital, Lille University, Lomme, France.
Department of Rheumatology, University-Hospital of Lille, Lille Cedex, France.
Am J Ther. 2019 May/Jun;26(3):e358-e363. doi: 10.1097/MJT.0000000000000645.
Methotrexate combination therapy improves abatacept efficacy as a first-line biologic agent for the treatment of rheumatoid arthritis, but it is unclear when abatacept is used later on, particularly after non-TNF inhibitor (TNFi) failure.
The objective of this study was to determine whether treatment response after non-TNFi inadequate response is different in patients with rheumatoid arthritis (RA) treated with abatacept in combination with or not with methotrexate.
Patients treated with abatacept monotherapy or in combination with methotrexate after non-TNFi failure were included.
Data from 46 patients aged 56 years [49-61] with 12 years [8-16] of disease duration were examined. Rituximab was the treatment used in the previous line for 75.0% of the combination therapy group (15/20) and 34.6% (9/26) in the monotherapy group. At 12 months, 38.5% (10/26) of patients were in good-to-moderate EULAR response in the monotherapy group compared with 25.0% (5/20) in the combination therapy group (P = 0.33). Treatment persistence at 12 months was 61.5% (16/26) in the monotherapy group and 35.0% (7/20) in the combination therapy group (P = 0.07).
Adding methotrexate to abatacept did not improve treatment response in patients with RA after non-TNFi inadequate response.
甲氨蝶呤联合治疗可提高阿巴西普作为类风湿关节炎一线生物制剂的疗效，但对于阿巴西普的后续使用时间尚不清楚，特别是在非 TNF 抑制剂（TNFi）失败后。
本研究旨在确定在类风湿关节炎（RA）患者中，阿巴西普联合或不联合甲氨蝶呤治疗，在非 TNFi 反应不足后，治疗反应是否不同。
纳入了阿巴西普单药或在非 TNFi 失败后联合甲氨蝶呤治疗的患者。
共分析了 46 例年龄为 56 岁[49-61]、病程 12 年[8-16]的患者数据。在联合治疗组（15/20）和单药治疗组（9/26）中，分别有 75.0%和 34.6%的患者在前一线使用了利妥昔单抗。在单药治疗组中，12 个月时 38.5%（10/26）的患者达到 EULAR 良好至中度反应，而在联合治疗组中为 25.0%（5/20）（P=0.33）。在单药治疗组中，12 个月时的治疗持续率为 61.5%（16/26），在联合治疗组中为 35.0%（7/20）（P=0.07）。
在非 TNFi 反应不足的 RA 患者中，添加甲氨蝶呤并不能改善阿巴西普的治疗反应。
