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郭强 三甲
郭强 主任医师
仁济医院 风湿病科

常规合成DMARDs的使用对脊柱关节炎有益吗?

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上海交通大学医学院附属仁济医院风湿病科郭强

肿瘤坏死因子抑制剂联合使用常规的合成DMARDs药物治疗脊柱关节炎患者的疗效维持作用:一项前瞻性队列研究

摘      要

 

目的

评价是否肿瘤坏死因子抑制剂(TNFi)联用常规的合成DMARDs(csDMARD)药物对脊柱关节炎(SpA)患者的疗效维持有作用。

 

方法

在2001年至2014年间,来自葡萄牙风湿病登记中心、首次使用TNFi治疗的SpA患者被纳入了本项研究。 使用Cox回归分析评估在两种模型中联用csDMARDs与TNFi的疗效维持作用,该两种模型是:1)时间固定的基线变量,以及2)时间变化的基线变量,基线变量包括社会人口学特征, 疾病活动度,身体功能的测量,以及与其他药物(非甾体抗炎药物和口服类固醇)的联合治疗。 为了控制因适应症可能引起的混杂因素,研究者还在调整治疗倾向得分后,评估了csDMARD联用TNFi对疗效维持的影响。

 

结果

总共有954例患者纳入研究,其中289例(30.3%)在中位随访时间2.5年(范围为0.08-13年)后停止了首次TNFi治疗。终止TNFi治疗的最常见原因是无效(55.7%)。 在多变量分析中,联用csDMARDs对TNFi疗效维持没有可测量的作用,无论是在基线模型(危险比[HR] 0.83, 95%置信区间[95%CI] 0.59-1.16)还是在调整时间协变量模型的随访期间(HR 1.07, 95%CI 0.68-1.68)。在调整倾向评分后,联用csDMARD对TNFi疗效维持的作用仍然不显著。

 

结论

在临床实践中,联用csDMARDs不能延长TNFi治疗SpA患者的疗效,提示联用这些药物没有获益。

原文


Effect of Comedication With Conventional Synthetic Disease-Modifying Antirheumatic Drugs on Retention of Tumor Necrosis Factor Inhibitors in Patients With Spondyloarthritis: A Prospective Cohort Study

Abstract

Objective

To evaluate whether use of comedication with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) influences the retention of tumor necrosis factor inhibitors (TNFi) in patients with spondyloarthritis (SpA).

Methods

Patients with SpA from the Rheumatic Diseases Portuguese Register who started treatment with their first TNFi between 2001 and 2014 were included in this study. Cox regression analysis was used to estimate the effect of comedication with csDMARDs on TNFi retention in 2 types of models: a model in which baseline (time-fixed) variables were included, and a second model incorporating time-varying variables, including sociodemographic features, measures of disease activity, measures of physical function, and cotreatment with other drugs (nonsteroidal antiinflammatory drugs and oral steroids). To control for possible confounding by indication, the effect of csDMARD comedication on TNFi retention was also tested after adjustment for the treatment propensity score.

Results

In total, 954 patients were included in the study, of whom 289 (30.3%) discontinued treatment with their first TNFi after a median follow-up time of 2.5 years (range 0.08–13 years). Inefficacy was the most common reason for TNFi discontinuation (55.7% of patients). In the multivariable analyses, comedication with csDMARDs had no measurable effect on TNFi retention, neither in the baseline model (hazard ratio [HR] 0.83, 95% confidence interval [95% CI] 0.59–1.16) nor during follow-up in the model adjusted for time-varying covariates (HR 1.07, 95% CI 0.68–1.68). The effect of csDMARD comedication remained nonsignificant after propensity score adjustment.

Conclusion

Comedication with csDMARDs does not prolong TNFi retention in patients with SpA in clinical practice, suggesting that there is no benefit conferred by the concomitant use of these drugs

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仁济医院 风湿病科
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