Rheumatology Unit, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome.
Rheumatology Unit, University of Messina, Messina.
Rheumatology (Oxford). 2018 Oct 1;57(57 Suppl 7):vii11-vii22. doi: 10.1093/rheumatology/key209.
To define the safety and efficacy of TNF inhibitors (TNFi) in RA patients with comorbidities.
A National Consensus Conference adopted a five-step process to better address the place of TNFi in the treatment of RA. Here we report the work focused on the influence of comorbidities on TNFi efficacy and the effect of TNFi on comorbidities using a Population Intervention Comparison Outcome-based strategy from 8 April 2013 to 15 January 2016.
A total of 4453 hits were analysed, of which 10 were eligible for full review. Data show that the presence of comorbidities influences the treatment strategy and several clinical outcomes. The risk of solid cancer is similar in RA patients treated with TNFi or with conventional synthetic DMARDs, and the risk of recurrent breast cancer is not higher in RA patients treated with TNFi. The risk of developing serious infections is higher in RA patients receiving TNFi than conventional synthetic DMARDs. Patients with previous serious infections before starting TNFi are not at increased risk of subsequent serious infection. The hazard rate of hospitalization due to infections is not different among patients remaining on the same TNFi, or switching to a different TNFi or to an agent with another mechanism of action. Longer exposure to TNFi is associated with a reduction in the risk of cardiovascular events.
Comorbidities affect RA treatment strategies and the efficacy of TNFi. TNFi treatment may decrease the risk of cardiovascular diseases and their use in patients with previous infection is not associated with a higher risk of recurrences.
确定合并症对类风湿关节炎患者使用肿瘤坏死因子抑制剂（TNFi）的安全性和疗效的影响。
全国共识会议采用五步流程，以更好地确定 TNFi 在类风湿关节炎治疗中的地位。我们在此报告的工作侧重于合并症对 TNFi 疗效的影响，以及从 2013 年 4 月 8 日至 2016 年 1 月 15 日采用基于人群干预比较结局的策略对 TNFi 对合并症的影响。
共分析了 4453 项研究结果，其中 10 项符合完整审查标准。数据表明，合并症会影响治疗策略和多种临床结局。接受 TNFi 或传统合成改善病情抗风湿药（csDMARDs）治疗的类风湿关节炎患者的实体瘤风险相似，且接受 TNFi 治疗的类风湿关节炎患者的乳腺癌复发风险并不更高。与接受 csDMARDs 治疗的患者相比，接受 TNFi 治疗的患者发生严重感染的风险更高。在开始接受 TNFi 治疗之前有过严重感染的患者，随后发生严重感染的风险并未增加。因感染而住院的风险在继续使用相同 TNFi、换用另一种 TNFi 或换用另一种作用机制的药物的患者中并无差异。更长时间使用 TNFi 与降低心血管事件风险相关。
合并症会影响类风湿关节炎的治疗策略和 TNFi 的疗效。TNFi 治疗可能降低心血管疾病的风险，且在有既往感染的患者中使用不会增加复发风险。
