Outcomes after switching from one anti-tumor necrosis factor α agent to a second anti-tumor necrosis factor α agent in patients with rheumatoid arthritis -: Results from a large UK national cohort study
Outcomes after switching from one anti-tumor necrosis factor α agent to a second anti-tumor necrosis factor α agent in patients with rheumatoid arthritis -: Results from a large UK national cohort study
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DOI：
10.1002/art.22331
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发表时间：
2007-01-01
影响因子：
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通讯作者：
Silman, Alan J.
中科院分区：
文献类型：
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作者：
Hyrich, Kimme L.;Lunt, Mark;Silman, Alan J.
Objective.类风湿性关节炎（RA）患者在使用一种抗肿瘤坏死因子（抗TNF）药物治疗失败后，由于无效或毒性，经常转换为第二种抗TNF药物，尽管转换的益处尚不清楚。本研究旨在比较第一疗程和第二疗程抗肿瘤坏死因子治疗的药物继续率。该研究涉及来自英国国家登记的RA患者的前瞻性队列，这些患者开始新的抗TNF治疗（n = 6，739; 876例开始阿达木单抗，2，826例开始依那西普，3，037例开始英夫利昔单抗）。在平均15个月的随访中，841名患者因无效而停止服用第一种药物，1，023名患者因毒性而停止服用第一种药物，其中分别有503名和353名患者改用第二种抗TNF药物。绘制Kaplan-Meier生存曲线以确定每个疗程的继续率，并使用考克斯回归分析比较每个疗程的停药风险和停药原因（无效或毒性）。总体而言，73%的患者转换为第二种抗TNF药物，在随访结束时仍在接受新的治疗。因无效而首次停药与因无效而第二次停药的发生率增加相关（风险比[HR] 2.7，95%置信区间[95% CI] 2.13.4），但与毒性无关（HR 1.1，95% CI 0.9- 1.5）。类似地，第一次因毒性而停药与第二次因毒性而停药的发生率增加相关（HR 2.3，95%CI 1.9-2.9），但与无效无关（HR 1.2，95%CI 0.8-1.6）。转换为第二种抗TNF药物的RA患者有很高的继续率，尽管在必须停止治疗的患者中，停止第二种药物的原因与停止第一种药物的原因有关。来自英国的这一大型数据集首次估计了长期严重RA患者的这些影响程度。
Objective. Patients with rheumatoid arthritis (RA) who experience treatment failure with one antitumor necrosis factor (anti-TNF) agent, due to either inefficacy or toxicity, are frequently switched to a second anti-TNF agent, although the benefits of switching are unknown. The present study was undertaken to compare drug continuation rates between the first course and second course of anti-TNF therapy.Methods. The study involved a prospective cohort of RA patients from a UK national register of new anti-TNF treatment starts (n = 6,739; 876 starting adalimumab, 2,826 starting etanercept, and starting 3,037 infliximab). Over a mean 15 months of followup, 841 patients stopped taking the first drug due to inefficacy and 1,023 stopped the first drug due to toxicity, of whom 503 and 353, respectively, were switched to a second anti-TNF agent. Kaplan-Meier survival curves were plotted to determine continuation rates for each course, and Cox regression was used to compare each course for the risk of stopping and the reason for stopping (inefficacy or toxicity).Results. Overall, 73% of patients who switched to a second anti-TNF agent remained on the new therapy by the end of followup. First drug discontinuation due to inefficacy was associated with an increased rate of second drug discontinuation due to inefficacy (hazard ratio [HR] 2.7, 95% confidence interval [95% CI] 2.13.4) but not toxicity (HR 1.1, 95% CI 0.9-1,.5). Similarly, first drug discontinuation due to toxicity was associated with an increased rate of second drug discontinuation due to toxicity (HR 2.3, 95% CI 1.9-2.9) but not inefficacy (HR 1.2, 95% CI 0.8-1.6).Conclusion. RA patients who are switched to a second anti-TNF drug have high rates of continuation, although among those who must discontinue treatment, the reasons for stopping a second drug are related to the reasons for stopping the first drug. This large data set from the UK provides the first estimates of the magnitude of these effects in patients with long-standing severe RA.