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李娟 三甲
李娟 副主任医师
海南医学院第一附属医院 风湿免疫科

TNF抑制剂与NSAID联合可预防AS患者再发葡萄膜炎

近日有研究比较肿瘤坏死因子(TNF)抑制剂和非甾体抗炎药(NSAID)对强直性脊柱炎(AS)患者葡萄膜炎的保护作用。这项回顾性队列研究纳入了2004年至2016年所有在首尔国立大学医院接受肿瘤坏死因子抑制剂或非甾体抗炎药治疗的AS患者(n=1055)。患者分为TNF抗体(n=517)、可溶性TNF受体融合蛋白(n=341)和非甾体抗炎药(n=704)。采用Cox比例风险模型比较各组葡萄膜炎的发生率。评估TNF抑制剂应用前后葡萄膜炎的发生率。采用倾向评分匹配法(PSM)进行敏感性分析。抗TNF抗体组葡萄膜炎的发生率明显低于NSAID组(调整后危险度(HR)0.53;95%可信区间(CI)0.29~0.96),而TNFR组(调整后HR 2.25,95%CI 1.43~3.53)明显高于NSAID组(P<0.05)。抗TNF抗体降低非甾体抗炎药治疗患者葡萄膜炎的发病率(调整HR 0.39;95%CI 0.19-0.79)。联合治疗对有葡萄膜炎病史的AS患者有预防作用(调整HR 0.31;95%CI 0.12-0.81),但对无葡萄膜炎史者则无预防作用。在非甾体抗炎药联合TNF抗体治疗后,葡萄膜炎的发病率由每100人6.36降至2.60。抗TNF抗体加非甾体抗炎药在有葡萄膜炎病史的患者中比单纯非甾体抗炎药物更能降低葡萄膜炎的风险。联合治疗可能是一种有效的二级预防措施。海南医学院第一附属医院风湿免疫科李娟

摘自:Kim MJ, Lee EE, Lee EY, et al. Preventive effect of tumor necrosis factor inhibitors versus nonsteroidal anti-inflammatory drugs on uveitis in patients with ankylosing spondylitis. Clinal Rheumatol. 2018 Oct;37(10):2763-2770. doi: 10.1007/s10067-018-4249-1. Epub 2018 Aug 4.

Abstract

To compare the preventive effect of tumor necrosis factor (TNF) inhibitors (anti-TNF antibody and soluble TNF receptor fusion protein (TNFR)) and nonsteroidal anti-inflammatory drugs (NSAIDS) on uveitis in patients with ankylosing spondylitis (AS). This retrospective cohort study included all AS patients (n=1055) who have been treated with either TNF inhibitor or NSAIDS at the Seoul National University Hospital from 2004 to 2016. Treatment episodes of each patient were assigned to anti-TNF antibody (n=517), TNFR (n=341), and NSAID (n=704) groups. The incidence of uveitis in each group was compared using a Cox proportional hazard model. The incidence rates of uveitis before and after initiation of TNF inhibitors were also assessed. A propensity score-matched (PSM) comparison was performed for a sensitivity analysis. Uveitis was significantly less common in the anti-TNF antibody group than the NSAID group (adjusted hazard ratio (HR) 0.53; 95% confidence interval (CI) 0.29-0.96) while it was higher in the TNFR group (adjusted HR 2.25, 95% CI 1.43-3.53). Anti-TNF antibody further reduced the incidence of uveitis when prescribed with NSAIDS (combination therapy) (adjusted HR 0.39; 95% CI 0.19-0.79). Combination therapy was preventive in AS patients with a history of uveitis (adjusted HR 0.31; 95% CI 0.12-0.81), but not in those without history of uveitis. The incidence rate of uveitis fell from 6.36 to 2.60 per 100 person-years when anti-TNF antibody was added to NSAIDS. Anti-TNF antibody plus NSAIDS reduces the risk of uveitis to a greater extent than NSAIDS alone in AS patients with a history of uveitis. Combination therapy may be an effective secondary prevention measure.

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李娟 副主任医师
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