男性和女性强直性脊柱炎患者对肿瘤坏死因子抑制的反应：来自瑞士队列的数据。
Response to Tumor Necrosis Factor Inhibition in Male and Female Patients with Ankylosing Spondylitis: Data from a Swiss Cohort.
机构信息
From the Swiss Clinical Quality Management Foundation; Department of Rheumatology, Zurich University Hospital, Zurich; Praxis Rheuma-Basel, Basel, Switzerland; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Ultrasound Center Rheumatology, Basel; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne; Department of Rheumatology, University Hospital, Geneva; Department of Rheumatology and Clinical Immunology, Inselspital, Bern; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland; Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands; Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin, Berlin, Germany; Department of Clinical Immunology and Rheumatology, University of Amsterdam; Department of Rheumatology, Zuyderland Hospital, Heerlen; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.
M. Hebeisen, MSc, Swiss Clinical Quality Management Foundation; R. Neuenschwander, Department of Rheumatology, Zurich University Hospital; A. Scherer, PhD, Swiss Clinical Quality Management Foundation; P. Exer, MD, Praxis Rheuma-Basel; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and South Jutland Hospital, Institute of Regional Health Research; G. Tamborrini, MD, Ultrasound Center Rheumatology; R. Micheroli, MD, Department of Rheumatology, Zurich University Hospital; L.M. Wildi, MD, Department of Rheumatology, Zurich University Hospital; P. Zufferey, MD, Department of Rheumatology, CHUV; M.J. Nissen, MD, Department of Rheumatology, University Hospital; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, Inselspital; J. Bernhard, MD, Department of Rheumatology and Rehabilitation, Bürgerspital; A. Finckh, MD, PhD, Department of Rheumatology, University Hospital; I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology, VU University Medical Center; J. Sieper, MD, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin; R. Landewé, MD, PhD, Department of Clinical Immunology and Rheumatology, University of Amsterdam, and Department of Rheumatology, Zuyderland Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital.
出版信息
J Rheumatol. 2018 Apr;45(4):506-512. doi: 10.3899/jrheum.170166. Epub 2018 Feb 15.
OBJECTIVE
To investigate sex differences in connection with the effectiveness of tumor necrosis factor inhibitors (TNFi) in patients with ankylosing spondylitis (AS).
METHODS
A total of 440 patients with AS (294 men; 146 women) initiating a first TNFi in the prospective Swiss Clinical Quality Management Cohort were included. We evaluated the proportion of patients achieving the 20% and 40% improvement in the Assessment of Spondyloarthritis international Society criteria (ASAS20 and ASAS40) as well as Ankylosing Spondylitis Disease Activity Score (ASDAS) improvement and status scores at 1 year. Patients having discontinued TNFi were considered nonresponders. Logistic regression analyses were performed to adjust for important predictors of response.
RESULTS
Compared to men, female patients had lower mean C-reactive protein levels, better spinal mobility, and more peripheral disease at the start. There was no sex disparity with regard to the ASDAS, the Bath Ankylosing Spondylitis Disease Activity and Functional indices, and the quality of life. At 1 year, 52% of women and 63% of men achieved an ASAS20 response (OR 0.63, 95% CI 0.37-1.07, p = 0.09). An inactive disease status (ASDAS < 1.3) was reached by 18% of women and 26% of men (OR 0.65, 95% CI 0.32-1.27, p = 0.22). These sex differences in response to TNFi were more pronounced in adjusted analyses (OR 0.34, 95% CI 0.16-0.71, p = 0.005 for ASAS20 and OR 0.10, 95% CI 0.03-0.31, p < 0.001 for ASDAS < 1.3) and confirmed for all the other outcomes assessed.
CONCLUSION
In AS, fewer women respond to TNFi and women show a reduced response in comparison to men.
目的
研究性别差异与肿瘤坏死因子抑制剂（TNFi）在强直性脊柱炎（AS）患者中的疗效的关系。
方法
共纳入 440 例在瑞士临床质量管理队列中首次接受 TNFi 治疗的 AS 患者（294 名男性；146 名女性）。我们评估了患者在第 1 年时达到 AS 国际评估协会标准（ASAS20 和 ASAS40）20%和 40%改善的比例，以及达到强直性脊柱炎疾病活动评分（ASDAS）改善和状态评分的比例。停止 TNFi 治疗的患者被认为是无应答者。进行逻辑回归分析以调整反应的重要预测因素。
结果
与男性相比，女性患者的平均 C 反应蛋白水平较低，脊柱活动度较好，外周疾病程度较低。在 ASDAS、巴斯强直性脊柱炎疾病活动和功能指数以及生活质量方面，男女之间没有差异。在第 1 年，52%的女性和 63%的男性达到 ASAS20 反应（OR 0.63，95%CI 0.37-1.07，p = 0.09）。18%的女性和 26%的男性达到疾病无活动状态（ASDAS<1.3）（OR 0.65，95%CI 0.32-1.27，p = 0.22）。在调整分析中，这些 TNFi 反应的性别差异更为明显（ASAS20 的 OR 0.34，95%CI 0.16-0.71，p = 0.005；ASDAS<1.3 的 OR 0.10，95%CI 0.03-0.31，p<0.001），并且确认了所有其他评估的结果。
结论
在 AS 中，女性对 TNFi 的反应较少，与男性相比，女性的反应降低。
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