Soubrier Martin, Pereira Bruno, Fan Angelique, Frayssac Thomas, Couderc Marion, Malochet-Guinamand Sandrine, Mathieu Sylvain, Tatar Zuzana, Tournadre Anne, Dubost Jean-Jacques
Rhumatologie, Clermont-Ferrand University Hospital, Hôpital Gabriel Montpied, Clermont-Ferrand, France.
DRCI, Clermont-Ferrand University Hospital, Hôpital Gabriel Montpied, Clermont-Ferrand, France.
Int J Rheum Dis. 2018 Nov;21(11):1986-1992. doi: 10.1111/1756-185X.13375. Epub 2018 Aug 30.
To compare, in real-life settings, the retention rates of initial anti-tumor-necrosis factor (TNF) treatments (etanercept [ETN], adalimumab [ADA] and infliximab [IFX]) used as first-line biotherapy for axial spondyloarthritis (axSpA), and evaluate treatment switches to another anti-TNF inhibitor in the event of treatment failure.
We analyzed the medical records of all SpA patients (Assessment in Ankylosing Spondylitis International Working Group axial criteria) treated with ETN, IFX or ADA between 2001 and February 2015. Drug retention rates were calculated using the Kaplan-Meier method and compared by means of the Cox extended model. Sub-analyses were performed according to discontinuation reasons.
Of the 249 SpA patients analyzed (135 radiographic cases, 114 non-radiographic), 102 received ETN, 62 ADA, and 85 IFX. In total, 103 discontinued treatment. The retention rates of IFX, ADA and ETN were 67%, 59% and 56% after 3 years; 62%, 42% and 47% after 5 years; 55%, 42% and 24% after 8 years; 53%, 42% and 12% after 10 years, respectively. In multivariate analyses, the predictive factors for retention were: low BASDAI score (hazard ratio [HR]: 1.02 [1.01-1.04]), high C-reactive protein levels (HR: 0.98 [0.97-0.99]), concomitant disease-modifying therapy (HR: 0.4 [0.21-0.75]), and radiographic SpA (HR: 1.5 [1.0-2.52]). In total, 61 patients switched to another anti-TNF therapy. No difference was observed among the three anti-TNF therapies regarding median retention duration, although the retention rate proved higher for treatment switches from one monoclonal antibody to another.
The retention rate in SpA patients proved high, with retention for IFX superior to that of ETN.
在实际临床环境中比较用于治疗中轴型脊柱关节炎（axSpA）一线生物疗法的初始抗肿瘤坏死因子（TNF）治疗药物（依那西普[ETN]、阿达木单抗[ADA]和英夫利昔单抗[IFX]）的保留率，并评估治疗失败时改用另一种抗TNF抑制剂的情况。
我们分析了2001年至2015年2月期间接受ETN、IFX或ADA治疗的所有SpA患者（采用强直性脊柱炎国际工作组中轴标准进行评估）的病历。使用Kaplan-Meier方法计算药物保留率，并通过Cox扩展模型进行比较。根据停药原因进行亚组分析。
在分析的249例SpA患者中（135例放射学病例，114例非放射学病例），102例接受ETN治疗，62例接受ADA治疗，85例接受IFX治疗。共有103例患者停止治疗。3年后IFX、ADA和ETN的保留率分别为67%、59%和56%；5年后分别为62%、42%和47%；8年后分别为55%、42%和24%；10年后分别为53%、42%和12%。在多变量分析中，保留的预测因素为：低巴斯强直性脊柱炎疾病活动指数（BASDAI）评分（风险比[HR]：1.02[1.01 - 1.04]）、高C反应蛋白水平（HR：0.98[0.97 - 0.99]）、联合使用改善病情的治疗（HR：0.4[0.21 - 0.75]）以及放射学SpA（HR：1.5[1.0 - 2.52]）。共有61例患者改用另一种抗TNF疗法。三种抗TNF疗法在中位保留持续时间方面未观察到差异，尽管从一种单克隆抗体改用另一种单克隆抗体的治疗保留率更高。
SpA患者的保留率较高，IFX的保留率优于ETN。
