Mo Qian, Dong Yuanji, Ye Cong, Zhong Jixin, Cai Shaozhe, Wang Min, Dong Lingli
Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Med (Lausanne). 2021 Dec 7;8:781088. doi: 10.3389/fmed.2021.781088. eCollection 2021.
In the clinic, some patients with axial spondyloarthritis (axSpA) have to reduce tumor necrosis factor inhibitor (TNFi) for various reasons. However, there are few studies about how to balance the relapse and TNFi reduction. Here we retrospectively analyzed the structural progression of the sacroiliac joint (SIJ) and clinical features in axSpA during TNFi reduction. A total of 108 patients with axSpA who followed up for 2 years and completed at least baseline, 12-month, and 24-month MRI scans of SIJ were divided into the tapering group ( = 63) and withdrawal group ( = 45) according to whether TNFi was stopped. We divided 2 years into five intervals, calculating the average dose quotient (DQ) for each of 540 intervals from 108 patients. By using generalized estimation equations with inverse probability of treatment weighting, we investigated the unbiased effects of average DQ on structural progression and treatment response. The disease activity (such as Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Disease Activity Score (ASDAS)-CRP, and ASDAS-ESR) and relapse rate were lower in the tapering group at 12 and 24 months ( < 0.05). Δerosion (β = -0.0100, = 0.00026) and Δthe Spondyloarthritis Research Consortium of Canada (SPARCC; β = -0.0959, < 0.0001) were negatively correlated with average DQ. The average DQ 30 (74.8%, 80.0%) or 41.6 (76.5%, 83%) was best to discriminate the status of treatment response or the status of bone marrow edema, but considering operability, the average DQ 25 (78.0%, 63.3%) was also acceptable especially for patients with HLA-B27 negative and non-severe fat metaplasia. Complete TNFi withdrawal was not recommended. Our study provided a referable strategy (tapering then maintained the average DQ over 30 or even 25) for patients who need TNFi reduction. Higher dose usage of TNFi was associated with a slower erosion progression of SIJ.
在临床上，一些轴性脊柱关节炎（axSpA）患者因各种原因不得不减少肿瘤坏死因子抑制剂（TNFi）的使用。然而，关于如何平衡复发与TNFi减量的研究较少。在此，我们回顾性分析了axSpA患者在TNFi减量过程中骶髂关节（SIJ）的结构进展及临床特征。共有108例随访2年且完成了至少基线、12个月及24个月SIJ MRI扫描的axSpA患者，根据是否停用TNFi分为减量组（n = 63）和停药组（n = 45）。我们将2年分为5个时间段，计算了108例患者540个时间段中每个时间段的平均剂量商（DQ）。通过使用具有治疗权重逆概率的广义估计方程，我们研究了平均DQ对结构进展和治疗反应的无偏效应。减量组在12个月和24个月时的疾病活动度（如巴斯强直性脊柱炎疾病活动指数（BASDAI）、巴斯强直性脊柱炎功能指数（BASFI）、强直性脊柱炎疾病活动评分（ASDAS）-CRP和ASDAS-ESR）及复发率较低（P < 0.05）。侵蚀量变化（β = -0.0100，P = 0.00026）和加拿大脊柱关节炎研究协会（SPARCC）评分变化（β = -0.0959，P < 0.0001）与平均DQ呈负相关。平均DQ为30（74.8%，80.0%）或41.6（76.5%，83%）最能区分治疗反应状态或骨髓水肿状态，但考虑到可操作性，平均DQ为25（78.0%，63.3%）也是可以接受的，尤其对于HLA-B27阴性且脂肪化生不严重的患者。不建议完全停用TNFi。我们的研究为需要减少TNFi使用的患者提供了一个可参考的策略（先减量然后维持平均DQ超过30甚至25）。较高剂量使用TNFi与SIJ侵蚀进展较慢相关。
