Non-TNF inhibitor switchers versus TNF inhibitor cyclers from multicentre rheumatoid arthritis ultrasonography prospective cohort in Japan
Non-TNF inhibitor switchers versus TNF inhibitor cyclers from multicentre rheumatoid arthritis ultrasonography prospective cohort in Japan
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DOI：
10.1080/25785826.2020.1757920
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发表时间：
2020-07-02
影响因子：
4.4
通讯作者：
Kawakami, Atsushi
中科院分区：
文献类型：
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作者：
Endo, Yushiro;Kawashiri, Shin-ya;Kawakami, Atsushi
使用包括能量多普勒超声（PDUS）成像评估在内的综合测量方法，比较肿瘤坏死因子抑制剂（TNFi）循环使用者和非TNFi转换使用者在对既往TNFi反应不佳的类风湿关节炎（RA）患者（TNF - IR患者）中的治疗效果。招募了对一种或多种既往TNFi药物反应不佳且疾病活动度为中度或更高的RA患者。对56名TNF - IR患者的结果进行了分析。患者被分为19名TNFi循环使用者和37名非TNFi转换使用者（16名阿巴西普[ABT]转换使用者和21名托珠单抗[TCZ]转换使用者）。6个月时的保留率在非TNFi转换使用者中显著高于TNFi循环使用者（p <.05）。尽管无显著差异，但基于临床疾病活动指数和PDUS，非TNFi转换使用者在疗效指标上的下降趋势比TNFi循环使用者更大。多变量逻辑回归分析确定了与欧洲抗风湿病联盟（EULAR）良好反应和生物制剂保留相关的以下独立因素：非TNFi转换（两者p <.05）。结果显示，非TNFi转换使用者的EULAR良好反应百分比和保留率显著高于TNFi循环使用者。因此，对于TNF - IR患者，非TNFi生物制剂可能是优先的二线治疗选择。
To compare therapeutic efficacy of tumour necrosis factor inhibitor (TNFi) cyclers and non-TNFi switchers in patients with rheumatoid arthritis (RA) having inadequate response to previous TNFis (TNF-IR patients) using composite measures including imaging assessment with power Doppler ultrasonography (PDUS). Patients with RA who had inadequate response to one or more previous TNFi agents with moderate or higher disease activity were enrolled. The outcomes of 56 TNF-IR patients were analysed. Patients were divided into 19 TNFi cyclers and 37 non-TNFi switchers (16 abatacept [ABT] and 21 tocilizumab [TCZ] switchers). Retention ratio at 6 months was significantly higher in non-TNFi switchers than in TNFi cyclers (p < .05). Although there was no significant difference, non-TNFi switchers tended to have a larger decrease than TNFi cyclers in efficacy indicators based on clinical disease activity index and PDUS. Multivariate logistic regression analysis identified a following independent factor associated with both EULAR good response and retention of a biologic agent: non-TNFi switch (p < .05 for both). Non-TNFi switchers were shown to have significantly higher percentage of EULAR good response and higher retention than TNFi cyclers. A non-TNFi biologic agent may hence be a preferential next-line treatment for TNF-IR patients.