在对 Janus 激酶抑制剂和后续生物制剂治疗反应不佳的难治性类风湿关节炎患者中，使用第二种 Janus 激酶抑制剂时的药物生存和疾病活动变化。
Drug survival and change of disease activity using a second janus kinase inhibitor in patients with difficult-to-treat rheumatoid arthritis who failed to a janus kinase inhibitor and subsequent biologics.
机构信息
Division of Rheumatology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam- gu, 06273, Seoul, Korea.
Division of Rheumatology, Department of Internal Medicine, College of Medicine, University of Ulsan, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, Korea.
出版信息
Adv Rheumatol. 2024 Apr 15;64(1):26. doi: 10.1186/s42358-024-00368-w.
BACKGROUND
To assess the drug survival and change of disease activity using a second Janus kinase inhibitor (JAKi) after failure to a JAKi and subsequent biologic disease-modifying anti-rheumatic drugs (bDMARDs) in patients with difficult-to-treat rheumatoid arthritis (RA).
METHODS
This retrospective cohort study included 32 patients with difficult-to-treat RA who failed to a JAKi and subsequently to one or more bDMARDs and then switched to a second JAKi. To assess drug survival, electronic medical records of each patient were reviewed. Data on whether the second JAKi was discontinued, and the reasons for discontinuation were collected. The change of disease activity was assessed by analyzing changes in tender joint count (TJC), swollen joint count (SJC), patient's global assessment of disease activity on a visual-analogue scale (VAS), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Disease Activity Score for 28 joints with ESR (DAS28-ESR), and DAS28-CRP from baseline to that at six months from initiation of the second JAKi.
RESULTS
Overall, discontinuation of the second JAKi occurred in 20 (62.5%) patients. Primary failure, secondary failure, adverse events, and insurance coverage issues were the reasons for discontinuation in 9 (45.0%), 5 (25.0%), 2 (10.0%), and 4 (20.0%) patients, respectively. The estimated 2-year drug survival rate was 39.3%. In terms of change of disease activity, the second JAKi significantly improved TJC (p < 0.001), SJC (p < 0.001), VAS (p < 0.001), CRP (p = 0.026), DAS28-ESR (p < 0.001), and DAS28-CRP (p < 0.001) at 6-month compared with that at the baseline.
CONCLUSIONS
Second JAKi could be a therapeutic option in patients with difficult-to-treat RA who have failed to a JAKi and subsequent bDMARDs.
背景
评估在使用一种 Janus 激酶抑制剂 (JAKi) 治疗失败后，对治疗困难的类风湿关节炎 (RA) 患者使用第二种 JAKi 和随后的生物疾病修饰抗风湿药物 (bDMARDs) 的药物生存情况和疾病活动变化。
方法
本回顾性队列研究纳入了 32 例治疗困难的 RA 患者，他们在使用 JAKi 治疗失败后，又相继使用了一种或多种 bDMARDs，然后改用第二种 JAKi。为了评估药物的生存情况，对每位患者的电子病历进行了回顾。收集了关于第二种 JAKi 是否停药以及停药原因的数据。通过分析从基线到开始使用第二种 JAKi 后 6 个月时的压痛关节数 (TJC)、肿胀关节数 (SJC)、患者对疾病活动的总体评估视觉模拟量表 (VAS)、红细胞沉降率 (ESR)、C 反应蛋白 (CRP)、红细胞沉降率 28 关节疾病活动评分 (DAS28-ESR) 和 CRP 的 DAS28 的变化来评估疾病活动的变化。
结果
总体而言，有 20 例 (62.5%) 患者停用了第二种 JAKi。9 例 (45.0%)、5 例 (25.0%)、2 例 (10.0%)和 4 例 (20.0%)患者停药的原因分别为原发性失效、继发性失效、不良事件和保险覆盖问题。预计 2 年药物生存率为 39.3%。在疾病活动变化方面，与基线相比，第二种 JAKi 显著改善了 TJC(p<0.001)、SJC(p<0.001)、VAS(p<0.001)、CRP(p=0.026)、DAS28-ESR(p<0.001)和 DAS28-CRP(p<0.001)。
结论
在使用 JAKi 治疗失败且随后使用 bDMARDs 治疗失败的治疗困难的 RA 患者中，第二种 JAKi 可能是一种治疗选择。
Zotero 插件