Chun Angela, Muhammad Lutfiyya N, De Ranieri Deirdre
Division of Rheumatology, Texas Children's Hospital, Houston, TX, USA.
Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
BMC Rheumatol. 2022 Mar 31;6(1):18. doi: 10.1186/s41927-022-00249-z.
There are many FDA-approved corticosteroid preparations available for intra-articular injection, however triamcinolone hexacetonide is not one of them. It was the intraarticular drug of choice among pediatric rheumatologists up until approximately a decade ago, when production of this medication ceased. It can be obtained in the United States and Canada via importation from Europe, but it is not FDA-approved at this time. We wish to compare the duration of remission of intraarticular triamcinolone hexacetonide (TH) with that of triamcinolone acetonide (TA) in children with juvenile idiopathic arthritis (JIA) and demonstrate its safety in this population.
This retrospective chart review included 39 patients with JIA who received intraarticular corticosteroid injections (IACIs) from September 2018 to September 2019. These patients were reviewed and their life-time injections with either TH (41 joints) or TA (124 joints) was noted through May 30, 2021. Patients with concomitant systemic therapy initiation were excluded. The primary outcome was time to relapse. Relapse was defined by the presence of arthritis on physical examination by an attending rheumatologist. Kaplan-Meier curves and a log-rank test were constructed to compare the probability of time to relapse between IACI injections. Additionally, mixed effects cox regression models were constructed to account for multiple injections per participant.
Kaplan-Meier estimator of median relapse time in months was higher for TH. Based on the log-rank test, TA joints had a higher probability of experiencing a relapse during the study time (p value < 0.001). The hazard of time to relapse was reduced when comparing TH to TA in both unadjusted and adjusted mixed effects cox regression models [unadjusted hazard ratio (95% confidence interval): 0.184 (0.089, 0.381); adjusted hazard ratio (95% confidence interval): 0.189 (0.092, 0.386)].
TH has longer duration of action than TA and is associated with less systemic side effects. It should be considered the drug of choice for intraarticular corticosteroid injections in children with JIA.
美国食品药品监督管理局（FDA）批准了多种可用于关节内注射的皮质类固醇制剂，但己曲安奈德不在其中。直到大约十年前这种药物停产之前，它一直是儿科风湿病学家首选的关节内用药。在美国和加拿大，可以通过从欧洲进口获得这种药物，但目前尚未获得FDA批准。我们希望比较己曲安奈德（TH）和曲安奈德（TA）在幼年特发性关节炎（JIA）患儿中的关节内注射缓解期，并证明其在该人群中的安全性。
这项回顾性图表审查纳入了39例在2018年9月至2019年9月期间接受关节内皮质类固醇注射（IACI）的JIA患儿。对这些患儿进行了审查，并记录了截至2021年5月30日他们使用TH（41个关节）或TA（124个关节）的终身注射情况。排除同时开始全身治疗的患儿。主要结局是复发时间。复发由主治风湿病学家通过体格检查发现关节炎来定义。构建Kaplan-Meier曲线和对数秩检验，以比较IACI注射之间复发时间的概率。此外，构建混合效应Cox回归模型以考虑每个参与者的多次注射。
TH的Kaplan-Meier估计中位复发时间（以月为单位）更高。基于对数秩检验，在研究期间TA关节复发的概率更高（p值<0.001）。在未调整和调整后的混合效应Cox回归模型中，与TA相比，TH复发时间的风险均降低[未调整风险比（95%置信区间）：0.184（0.089，0.381）；调整后风险比（95%置信区间）：0.189（0.092，0.386）]。
TH的作用持续时间比TA长，且全身副作用较少。它应被视为JIA患儿关节内皮质类固醇注射的首选药物。
