Lindström Ulf, Olofsson Tor, Wedrén Sara, Qirjazo Ilia, Askling Johan
Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
Department of Clinical Sciences, Lund University, Lund, Sweden.
RMD Open. 2018 Oct 15;4(2):e000762. doi: 10.1136/rmdopen-2018-000762. eCollection 2018.
To assess the impact of extra-articular spondyloarthritis (SpA) manifestations (anterior uveitis, psoriasis and inflammatory bowel disease (IBD)), and of comorbidities, on tumour necrosis factor alpha inhibitor (TNFi) drug retention in ankylosing spondylitis (AS).
We identified all bio-naïve patients with AS starting a first ever TNFi July 2006 to December 2015 from the Swedish Rheumatology Quality register and followed these from treatment start through December 2015. We determined the presence of extra-articular SpA-manifestations, comorbidities (cardiovascular disease, affective disease, diabetes, malignancies, chronic lung disease and kidney disease) and socioeconomic status before TNFi start, through linkage to five other national registers, and calculated, for each factor, crude and adjusted HRs for discontinuing the TNFi.
2577 patients with AS (71% men) started a first TNFi during the study period. 27% had a history of anterior uveitis, 6% psoriasis and 7% IBD. Anterior uveitis was associated with a superior TNFi drug retention (HR 0.72; 0.62 to 0.83), psoriasis with an inferior (HR 1.48; 1.18 to 1.86), whereas IBD did not affect TNFi drug retention. The effect of the SpA manifestations on TNFi drug retention was of a similar magnitude to that of the comorbidities.
In AS, anterior uveitis and psoriasis, but not IBD, affect TNFi drug retention. Possible explanations include differential effects of TNFi on these extra-articular SpA manifestations, or inherent differences in AS, associated with the inflammatory phenotype. Further, comorbidities and socioeconomy affect TNFi drug retention to a similar magnitude as the SpA manifestations, and should, as such, receive due attention in clinical practice.
评估关节外脊柱关节炎（SpA）表现（前葡萄膜炎、银屑病和炎症性肠病（IBD））以及合并症对强直性脊柱炎（AS）患者肿瘤坏死因子α抑制剂（TNFi）药物留存率的影响。
我们从瑞典风湿病质量登记处识别出2006年7月至2015年12月开始首次使用TNFi的所有初治AS患者，并从治疗开始一直随访至2015年12月。通过与其他五个国家登记处的数据关联，我们确定了在开始使用TNFi之前患者是否存在关节外SpA表现、合并症（心血管疾病、情感性疾病、糖尿病、恶性肿瘤、慢性肺病和肾病）以及社会经济状况，并计算了每个因素导致停用TNFi的粗风险比（HR）和调整后HR。
在研究期间，2577例AS患者（71%为男性）开始首次使用TNFi。27%的患者有前葡萄膜炎病史，6%有银屑病，7%有IBD。前葡萄膜炎与较高的TNFi药物留存率相关（HR 0.72；0.62至0.83），银屑病与较低的留存率相关（HR 1.48；1.18至1.86），而IBD不影响TNFi药物留存率。SpA表现对TNFi药物留存率的影响程度与合并症相似。
在AS中，前葡萄膜炎和银屑病会影响TNFi药物留存率，而IBD则不会。可能的解释包括TNFi对这些关节外SpA表现的不同作用，或与炎症表型相关的AS内在差异。此外，合并症和社会经济状况对TNFi药物留存率的影响程度与SpA表现相似，因此在临床实践中应给予应有的关注。
