Kaya Mehmet Nur, Tecer Duygu, Kılıç Özlem, Yılmaz Sedat
University of Health Sciences Turkey, Gülhane Training and Research Hospital, Rheumatology Department, Ankara, Turkey.
Int J Rheum Dis. 2025 Apr;28(4):e70212. doi: 10.1111/1756-185X.70212.
Evaluation of drug survival and predictive factors of alternative tumor necrosis factor inhibitor (TNFi) and secukinumab (SEC) use after TNFi therapy in patients with axial spondyloarthritis (axSpA).
This was an observational retrospective study of axSpA patients who switched to second-line biological disease modifying antirheumatic drugs (bDMARD) between January 2018 and February 2023. Drug retention rate was evaluated using Kaplan-Meier analysis and log-rank test. Factors associated with drug survival of the second bDMARD were analyzed by multivariate regression analyses.
A total of 201 axSpA patients (alternative TNFi: 143 patients, SEC: 58 patients) with a mean age 37.1 ± 8.6 years and consist of 58.2% male were included. Clinical characteristics and laboratory results at switching were comparable between groups. During a median follow-up period of 22.3 months, 80 (39.8%) of 201 patients discontinued bDMARD. Median follow-up period, drug discontinuation frequency, and drug retention rate were similar between groups. C-reactive protein (CRP) level (Hazard ratio (HR) = 0.98, 95% confidence interval (CI) = 0.95-0.99, p = 0.032) and primary failure (HR = 1.52, 95% CI = 1.03-2.27, p = 0.037) were significantly associated with the risk of TNFi discontinuation. Smoking (HR = 1.96, 95% CI = 1.05-3.69, p = 0.036) and Achilles enthesitis (HR = 1.93, 95% CI = 1.09-3.40, p = 0.024) were significantly associated with the risk of SEC discontinuation.
In axSpA exposed to a TNFi, switching to a second TNFi has comparable effectiveness to switching to SEC. SEC may be a better option in patients who experienced primary failure of TNFi, whereas an alternative TNFi may be preferred in patients with higher CRP levels or Achilles enthesitis, or who are currently smoking.
评估强直性脊柱炎（axSpA）患者在肿瘤坏死因子抑制剂（TNFi）治疗后改用二线生物改善病情抗风湿药（bDMARD）时，改用其他肿瘤坏死因子抑制剂（TNFi）和司库奇尤单抗（SEC）的药物留存率及预测因素。
这是一项针对2018年1月至2023年2月期间改用二线bDMARD的axSpA患者的观察性回顾性研究。使用Kaplan-Meier分析和对数秩检验评估药物留存率。通过多因素回归分析分析与第二种bDMARD药物留存相关的因素。
共纳入201例axSpA患者（改用其他TNFi：143例患者，SEC：58例患者），平均年龄37.1±8.6岁，男性占58.2%。两组在换药时的临床特征和实验室检查结果具有可比性。在中位随访期22.3个月期间，201例患者中有80例（39.8%）停用了bDMARD。两组的中位随访期、药物停药频率和药物留存率相似。C反应蛋白（CRP）水平（风险比（HR）=0.98，95%置信区间（CI）=0.95-0.99，p=0.032）和初次治疗失败（HR=1.52，95%CI=1.03-2.27，p=0.037）与TNFi停药风险显著相关。吸烟（HR=1.96，95%CI=1.05-3.69，p=0.036）和跟腱附着点炎（HR=1.93，95%CI=1.09-3.40，p=0.024）与SEC停药风险显著相关。
在接受TNFi治疗的axSpA患者中，改用第二种TNFi与改用SEC的疗效相当。对于TNFi初次治疗失败的患者，SEC可能是更好的选择；而对于CRP水平较高、患有跟腱附着点炎或正在吸烟的患者，改用其他TNFi可能更合适。
