Stober Carmel, Ye Weiyu, Guruparan Thushyanthan, Htut Eiphyu, Clunie Gavin, Jadon Deepak
Department of Rheumatology, Addenbrooke's Hospital.
Department of Medicine, Cambridge University Hospitals NHS FT.
Rheumatology (Oxford). 2018 Jan 1;57(1):158-163. doi: 10.1093/rheumatology/kex387.
To evaluate TNF-α inhibitor (TNFi) persistence when used as first- or second-line biologic therapy for the management of PsA, and to determine baseline clinical and laboratory parameters associated with TNFi persistence.
A retrospective single-centre cohort study was performed on all patients with PsA initiated on TNFi therapy between 2003 and 2015. Demographic, clinical and laboratory characteristics were compared with TNFi persistence, using Kaplan-Meier survival and Cox proportional hazards models.
One hundred and eighty-eight patients with PsA were prescribed TNFi therapy as first-line biologic therapy over a period of 635 person-years [46% male, mean (s.d.) age 47.3 (11.4) years; median (interquartile range) disease duration 11 (7-16) years]. At 12 months of follow-up 79% of patients persisted with TNFi therapy, and 73% at 24 months. Of those discontinuing TNFi, 35% stopped due to primary inefficacy, 22% secondary inefficacy and 43% adverse events. Multivariable analysis identified female sex (hazard ratio (HR) 2.57; 95% CI: 1.26, 5.24; P = 0.01) and the presence of metabolic syndrome-related co-morbidities (HR = 2.65, 95% CI: 1.24, 5.69; P = 0.01) as predictors of lower persistence. Of 32 cases treated with a second TNFi, persistence at 12 months was 56%. TNFi persistence was 2-fold less likely in these 32 cases compared with first-line TNFi users (HR = 2.02, 95% CI: 1.20, 3.42; P = 0.01).
Patients with PsA who are female and have metabolic syndrome-related co-morbidities have lower TNFi persistence. Although persistence was lower in patients who had switched to a second TNFi, a substantial proportion of these cases responded, advocating switching to a second TNFi as a valid therapeutic strategy.
评估肿瘤坏死因子-α抑制剂（TNFi）作为一线或二线生物治疗用于银屑病关节炎（PsA）管理时的持续使用情况，并确定与TNFi持续使用相关的基线临床和实验室参数。
对2003年至2015年间开始接受TNFi治疗的所有PsA患者进行回顾性单中心队列研究。使用Kaplan-Meier生存分析和Cox比例风险模型，将人口统计学、临床和实验室特征与TNFi持续使用情况进行比较。
在635人年的时间里，188例PsA患者被处方TNFi作为一线生物治疗[男性占46%，平均（标准差）年龄47.3（11.4）岁；疾病持续时间中位数（四分位间距）为11（7 - 16）年]。随访12个月时，79%的患者持续使用TNFi治疗，24个月时为73%。在停用TNFi的患者中，35%因原发性无效停药，22%因继发性无效停药，43%因不良事件停药。多变量分析确定女性（风险比[HR] 2.57；95%置信区间：1.26，5.24；P = 0.01）和存在与代谢综合征相关的合并症（HR = 2.65，95%置信区间：1.24，5.69；P = 0.01）是持续使用可能性较低的预测因素。在32例接受第二种TNFi治疗的患者中，12个月时的持续使用率为56%。与一线TNFi使用者相比，这32例患者中TNFi持续使用的可能性低2倍（HR = 2.02，95%置信区间：1.20，3.42；P = 0.01）。
患有PsA的女性和存在与代谢综合征相关合并症的患者TNFi持续使用率较低。尽管改用第二种TNFi的患者持续使用率较低，但这些病例中有很大一部分有反应，这表明改用第二种TNFi是一种有效的治疗策略。
