A novel scoring system based on common laboratory tests predicts the efficacy of TNF-inhibitor and IL-6 targeted therapy in patients with rheumatoid arthritis: a retrospective, multicenter observational study.
A novel scoring system based on common laboratory tests predicts the efficacy of TNF-inhibitor and IL-6 targeted therapy in patients with rheumatoid arthritis: a retrospective, multicenter observational study.
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DOI：
10.1186/s13075-017-1387-9
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发表时间：
2017-08-11
影响因子：
4.9
通讯作者：
Akashi K
中科院分区：
文献类型：
--
作者：
Nakagawa J;Koyama Y;Kawakami A;Ueki Y;Tsukamoto H;Horiuchi T;Nagano S;Uchino A;Ota T;Akahoshi M;Akashi K
目前，尽管有几类生物疾病缓解抗风湿药物（bDMARD）可用，但很少有数据告知类风湿性关节炎（RA）个体患者初始治疗的选择。因此，在最近的疾病管理建议中，肿瘤坏死因子抑制剂（TNF-i）和托珠单抗（TCZ）被视为等效治疗方法。我们专注于两种抗细胞因子疗法，TCZ 和 TNF-i，旨在开发一个评分系统，在开始 IL-6 或 TNF-i 之前预测每位 RA 患者的更好治疗方案。通过DNA微阵列检测45例新诊断的RA患者外周血中IL-6和TNF-α mRNA的表达，以评估细胞因子的激活。接下来，对 98 名接受 TCZ 或 TNF-i 治疗的患者在开始治疗前的实验室指标和 6 个月后的疾病活动评分改善率进行回顾性分析。选择了一些与 TCZ 功效相关的指数，并通过受试者工作特征 (ROC) 分析定义了它们的截止值，以开发评分系统来区分更有可能对 TCZ 或 TNF-i 做出反应的个体。评分系统的有效性在这 98 名患者和另外 228 名患者中得到了验证。初诊RA患者IL-6与TNF-α mRNA表达量呈显着负相关。对 98 名患者的分析显示 TCZ 疗效与血小板计数、血红蛋白、天冬氨酸转氨酶和丙氨酸转氨酶之间存在显着相关性；相比之下，TNF-i 组则没有类似的相关性。通过 ROC 分析定义截止值以开发评分系统（1 分/项目，最多 4 分）。如果分数≥2，则预测 TCZ 反应良好；相反，如果分数≤1，则TNF-i似乎更可取。对另外 228 名患者进行的验证研究也获得了类似的结果。如果病例得分≥3，TCZ/TNF-i的良好反应率分别为75.0%/37.9%（p<0.01），无反应率分别为3.1%/27.6%（p<0.01）。根据常见的实验室结果可以轻松计算出分数。它对于在选择 IL-6 或 TNF 抑制剂时确定更好的治疗方法似乎很有用。
Currently, although several categories of biological disease-modifying antirheumatic drugs (bDMARDs) are available, there are few data informing selection of initial treatment for individual patients with rheumatoid arthritis (RA). Therefore, tumor necrosis factor inhibitor (TNF-i) and tocilizumab (TCZ) are treated as equivalent treatments in the recent disease management recommendations. We focused on two anticytokine therapies, TCZ and TNF-i, and aimed to develop a scoring system that predicts a better treatment for each RA patient before starting an IL-6 or a TNF-i. The expression of IL-6 and TNF-α mRNA in peripheral blood from 45 newly diagnosed RA patients was measured by DNA microarrays to evaluate cytokine activation. Next, laboratory indices immediately before commencing treatment and disease activity score improvement ratio after 6 months in 98 patients treated with TCZ or TNF-i were retrospectively analyzed. Some indices correlated with TCZ efficacy were selected and their cutoff values were defined by receiver operating characteristic (ROC) analysis to develop a scoring system to discriminate between individuals more likely to respond to TCZ or TNF-i. The validity of the scoring system was verified in these 98 patients and an additional 228 patients. There was significant inverse correlation between the expression of IL-6 and TNF-α mRNA in newly diagnosed RA patients. The analysis of 98 patients revealed significant correlation between TCZ efficacy and platelet counts, hemoglobin, aspartate aminotransferase, and alanine aminotransferase; in contrast, there was no similar correlation in the TNF-i group. The cutoff values were defined by ROC analysis to develop a scoring system (1 point/item, maximum of 4 points). A good TCZ response was predicted if the score was ≥2; in contrast, TNF-i seemed to be preferable if the score was ≤1. Similar results were obtained in a validation study of an additional 228 patients. If the case scored ≥3, the good responder rates of TCZ/TNF-i were 75.0%/37.9% (p < 0.01) and the non-responder rates were 3.1%/27.6% (p < 0.01), respectively. The score is easily calculated from common laboratory results. It appears useful for identifying a better treatment at the time of selecting either an IL-6 or a TNF inhibitor.
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影响因子：
27.4
作者：
Burmester, Gerd R.;Feist, E.;Rubbert-Roth, A.
通讯作者：
Rubbert-Roth, A.
影响因子：
64.8
作者：
DESAUVAGE, FJ;HASS, PE;EATON, DL
通讯作者：
EATON, DL
影响因子：
--
作者：
Emery, P;Fleischmann, R;Shaw, TM
通讯作者：
Shaw, TM
影响因子：
20.3
作者：
GORDON, MS;NEMUNAITIS, J;NIMER, SD
通讯作者：
NIMER, SD
DOI：
10.1016/j.bbrc.2003.08.085
发表时间：
2003-10-03
影响因子：
3.1
作者：
James, LP;Lamps, LW;Hinson, JA
通讯作者：
Hinson, JA