The First Department of Internal Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Fukuoka, Japan.
The First Department of Internal Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Fukuoka, Japan.
Clin Immunol. 2018 Jun;191:67-74. doi: 10.1016/j.clim.2018.03.018. Epub 2018 Mar 31.
The aim of this study was to compare the clinical outcome of patients with rheumatoid arthritis seen in routine clinical practice treated with either TNF inhibitors or abatacept. To overcome potential bias, both propensity score matching and Inverse Probability of Treatment Weighting were used for patient selection. The propensity score matching procedure selected 315 matched pairs of patients who were treated with TNF inhibitors or abatacept. At week 52, SDAI in TNF inhibitors was lower than abatacept. In contrast, analysis of biologics-naive patients using the propensity-score matching (n = 150; in each group) showed comparable clinical efficacy. Consistent results were obtained by the use of Inverse Probability of Treatment Weighting (581 patients treated with TNF inhibitors and 353 patients treated with abatacept). The predictors of response to each treatment were different; abatacept appeared to benefit patients with high baseline RF titers while TNF inhibitors appeared to benefit patients with low baseline HAQ-DI.
本研究旨在比较常规临床实践中接受 TNF 抑制剂或阿巴西普治疗的类风湿关节炎患者的临床结局。为了克服潜在的偏倚,本研究同时采用倾向评分匹配和逆概率处理加权法进行患者选择。倾向评分匹配程序选择了 315 对接受 TNF 抑制剂或阿巴西普治疗的匹配患者。在第 52 周,TNF 抑制剂治疗组的 SDAI 低于阿巴西普治疗组。相反,采用倾向评分匹配(每组 n=150;共 300 例患者)分析生物制剂初治患者的结果显示,两者的临床疗效相当。采用逆概率处理加权法(共 581 例接受 TNF 抑制剂治疗的患者和 353 例接受阿巴西普治疗的患者)也得到了一致的结果。两种治疗方法的反应预测因素不同;阿巴西普似乎对基线 RF 滴度高的患者有益,而 TNF 抑制剂似乎对基线 HAQ-DI 低的患者有益。