Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455 3° andar - sala 3131 - Cerqueira César, São Paulo, SP, Cep: 01246-903, Brazil.
Adv Rheumatol. 2018 Dec 4;58(1):40. doi: 10.1186/s42358-018-0040-x.
To determine the clinical and demographic factors associated with disease remission and drug survival in patients with ankylosing spondylitis (AS) on TNF inhibitors.
Data from a longitudinal electronic database of AS patients under anti-TNF therapy between June/2004 and August/2013. Demographic, clinical parameters, disease activity by ASDAS remission (< 1.3) and inactive/low (< 2.1) were analyzed to characterize reasons for drug survival and switching of anti-TNF.
Among 117 AS patients, 69 (59%) were prescribed only one anti-TNF, 48 (41%) switched to a second anti-TNF and 13 (11%) to a third anti-TNF. Considering ASDAS-CRP < 1.3, 31 (39%) patients were inactive at the end of the study. Non-switchers (P = 0.04), younger age (P = 0.004), non-smoking (P = 0.016), shorter disease duration (P = 0.047), more frequent use of SSZ (P = 0.037) and lower BASDAI (P = 0.027), BASMI (P = 0.034) and BASFI (P = 0.003) at baseline were associated with remission. In the multivariate analysis younger age (P = 0.016) and lower BASDAI (P = 0.032) remained as remission predictors.
This study supports that ASDAS-CRP remission is an achievable goal not only for non-switchers but also for second anti-TNF, particularly in patients with younger age and lower BASDAI at baseline. Co-medication and non-smoker status seems to have a beneficial effect in anti-TNF response in this population.
确定与接受 TNF 抑制剂治疗的强直性脊柱炎（AS）患者疾病缓解和药物存活相关的临床和人口统计学因素。
使用 2004 年 6 月至 2013 年 8 月间接受抗 TNF 治疗的 AS 患者纵向电子数据库的数据。分析人口统计学、临床参数、通过 ASDAS 缓解（<1.3）和无活动/低疾病活动（<2.1）评估的疾病活动度，以确定药物存活和 TNF 转换的原因。
在 117 例 AS 患者中，69 例（59%）仅接受了一种抗 TNF，48 例（41%）转换为第二种抗 TNF，13 例（11%）转换为第三种抗 TNF。考虑到 ASDAS-CRP<1.3，31 例（39%）患者在研究结束时无活动。非转换者（P=0.04）、年龄较小（P=0.004）、不吸烟（P=0.016）、疾病持续时间较短（P=0.047）、更频繁使用 SSZ（P=0.037）以及基线时 BASDAI（P=0.027）、BASMI（P=0.034）和 BASFI（P=0.003）较低与缓解相关。多变量分析显示，年龄较小（P=0.016）和 BASDAI 较低（P=0.032）是缓解的预测因素。
这项研究支持，ASDAS-CRP 缓解不仅是未转换者的一个可行目标，也是二线抗 TNF 治疗的一个可行目标，尤其是在基线时年龄较小和 BASDAI 较低的患者中。在该人群中，合并用药和不吸烟状态似乎对 TNF 反应有有益影响。
