阿巴西普单药治疗与联合治疗类风湿关节炎间质性肺病的多中心研究：263例白种人患者
Abatacept in monotherapy vs combined in interstitial lung disease of rheumatoid arthritis-multicentre study of 263 Caucasian patients.
作者信息
Fernández-Díaz Carlos, Atienza-Mateo Belén, Castañeda Santos, Melero-Gonzalez Rafael B, Ortiz-SanJuan Francisco, Loricera Javier, Casafont-Solé Ivette, Rodríguez-García Sebastián, Aguilera-Cros Clara, Villa-Blanco Ignacio, Raya-Alvarez Enrique, Ojeda-García Clara, Bonilla Gema, López-Robles Alejandra, Arboleya Luis, Narváez Javier, Cervantes Evelin, Maiz Olga, Alvarez-Rivas María N, Cabezas Iván, Salgado Eva, Hidalgo-Calleja Cristina, Fernández Sabela, Fernández Jesús C, Ferraz-Amaro Ivan, González-Gay Miguel A, Blanco Ricardo
机构信息
Rheumatology, HU Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
Rheumatology, HU La Princesa, IIS-Princesa, Cátedra UAM-Roche (EPID-Future), Madrid, UAM, Spain.
出版信息
Rheumatology (Oxford). 2021 Dec 24;61(1):299-308. doi: 10.1093/rheumatology/keab317.
OBJECTIVE
To assess the efficacy and safety of abatacept (ABA) in monotherapy (ABAMONO) vs combined ABA [ABA plus MTX (ABAMTX) or ABA plus non-MTX conventional synthetic DMARDs (csDMARDs) (ABANON-MTX)] in RA patients with interstitial lung disease (ILD) (RA-ILD).
METHODS
This was a restrospective multicentre study of RA-ILD Caucasian patients treated with ABA. We analysed in the three groups (ABAMONO, ABAMTX, ABANON-MTX) the following outcome variables: (i) dyspnoea; (ii) forced vital capacity (FVC) and diffusion capacity of the lung for the carbon monoxide (DLCO); (iii) chest high-resolution CT (HRCT); (iv) DAS28-ESR; (v) CS-sparing effect; and (vi) ABA retention and side-effects. Differences between basal and final follow-up were evaluated. Multivariable linear regression was used to assess the differences between the three groups.
RESULTS
We studied 263 RA-ILD patients (mean ± s.d. age 64.6 ± 10 years) [ABAMONO (n = 111), ABAMTX (n = 46) and ABANON-MTX (n = 106)]. At baseline, ABAMONO patients were older (67 ± 10 years) and took higher prednisone dose [10 (interquartile range 5-15) mg/day]. At that time, there were no statistically significant differences in sex, seropositivity, ILD patterns, FVC and DLCO, or disease duration. Following treatment, in all groups, most patients experienced stabilization or improvement in FVC, DLCO, dyspnoea and chest HRCT as well as improvement in DAS28-ESR. A statistically significant difference between basal and final follow-up was only found in CS-sparing effect in the group on combined ABA (ABAMTX or ABANON-MTX). However, in the multivariable analysis, there were no differences in any outcome variables between the three groups.
CONCLUSION
In Caucasian individuals with RA-ILD, ABA in monotherapy or combined with MTX or with other conventional-DMARDs seems to be equally effective and safe. However, a CS-sparing effect is only observed with combined ABA.
目的
评估阿巴西普（ABA）单药治疗（ABAMONO）与联合ABA治疗[ABA联合甲氨蝶呤（ABAMTX）或ABA联合非甲氨蝶呤传统合成改善病情抗风湿药（csDMARDs）（ABANON - MTX）]对类风湿关节炎合并间质性肺疾病（ILD）（RA - ILD）患者的疗效和安全性。
方法
这是一项对接受ABA治疗的RA - ILD白种患者的回顾性多中心研究。我们在三组（ABAMONO、ABAMTX、ABANON - MTX）中分析了以下结局变量：（i）呼吸困难；（ii）用力肺活量（FVC）和肺一氧化碳弥散量（DLCO）；（iii）胸部高分辨率CT（HRCT）；（iv）DAS28 - ESR；（v）糖皮质激素节省效应；（vi）ABA保留率和副作用。评估基线与最终随访之间的差异。采用多变量线性回归评估三组之间的差异。
结果
我们研究了263例RA - ILD患者（平均±标准差年龄64.6±10岁）[ABAMONO组（n = 111）、ABAMTX组（n = 46）和ABANON - MTX组（n = 106）]。基线时，ABAMONO组患者年龄较大（67±10岁）且泼尼松剂量较高[10（四分位间距5 - 15）mg/天]。当时，在性别、血清学阳性、ILD类型、FVC和DLCO或病程方面无统计学显著差异。治疗后，所有组中大多数患者的FVC、DLCO、呼吸困难和胸部HRCT均趋于稳定或改善，DAS28 - ESR也有所改善。仅在联合ABA治疗组（ABAMTX或ABANON - MTX）的糖皮质激素节省效应方面发现基线与最终随访之间存在统计学显著差异。然而，在多变量分析中，三组之间在任何结局变量上均无差异。
结论
在患有RA - ILD的白种人中，ABA单药治疗或与MTX或其他传统DMARDs联合治疗似乎同样有效且安全。然而，仅联合ABA治疗可观察到糖皮质激素节省效应。
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