Treatment Response, Drug Survival, and Predictors Thereof in 764 Patients With Psoriatic Arthritis Treated With Anti-Tumor Necrosis Factor α Therapy Results From the Nationwide Danish DANBIO Registry
Treatment Response, Drug Survival, and Predictors Thereof in 764 Patients With Psoriatic Arthritis Treated With Anti-Tumor Necrosis Factor α Therapy Results From the Nationwide Danish DANBIO Registry
复制标题
DOI：
10.1002/art.30117
复制
发表时间：
2011-02-01
影响因子：
--
通讯作者：
Hetland, Merete Lund
中科院分区：
文献类型：
--
作者：
Glintborg, Bente;Ostergaard, Mikkel;Hetland, Merete Lund
目标。研究丹麦银屑病关节炎(PSA)患者首次接受肿瘤坏死因子α(TNFα)抑制剂治疗的疾病活动性、治疗反应、药物存活率及其预测因素。PSA患者是从丹麦生物制剂注册数据库DANBIO的全国风湿病数据库中确定的，使用的是2000年至2009年注册的数据。获得患者对抗肿瘤坏死因子α治疗的临床反应(定义为在治疗的前6个月内至少达到美国风湿病学会20%[ACR20]、ACR50和ACR70改善标准或欧洲风湿病联盟[EULAR]良好反应一次)、药物依从性(称为药物存活率)和药物依从率及其预测因素。在764名PSA患者中，320名接受阿达利玛单抗治疗，260名接受英夫利昔单抗治疗，184名接受依那西普治疗。中位药物生存期为2.9年，1年和2年的药物生存率分别为70%和57%。6个月后有改善的临床参数包括C反应蛋白(CRP)水平、健康评估问卷评分和28关节疾病活动度评分。男性、C反应蛋白水平和10毫克/升、同时使用甲氨蝶呤以及基线时患者健康视觉模拟评分较低与较长的药物存活期相关。根据ACR20、ACR50、ACR70和EULAR良好反应标准，分别有59%、45%、24%和54%的患者获得改善。C反应蛋白水平10 mg/L是改善反应的预测指标(OR值分别为ACR20 2.6、ACR50 3.0、ACR70 3.6和EULAR良好反应OR2.2)。在这些在临床实践中首次使用肿瘤坏死因子α抑制剂治疗的PSA患者中，观察到高药物依从性和应答率。此外，基线时C反应蛋白水平的升高与良好的治疗反应和持续治疗有关，这可能对选择最有可能从肿瘤坏死因子α抑制剂治疗中受益的患者具有临床价值。
Objective. To investigate disease activity, treatment response, and drug survival, and predictors thereof, among Danish patients with psoriatic arthritis (PsA) receiving their first treatment series with a tumor necrosis factor alpha (TNF alpha) inhibitor.Methods. Patients with PsA were identified from a prospective nationwide rheumatologic database, the Danish biologics registry DANBIO, using data registered from 2000-2009. Information was obtained on the patients' clinical response to anti-TNF alpha treatment (defined as achievement of the American College of Rheumatology 20% [ACR20], ACR50, and ACR70 improvement criteria or a European League Against Rheumatism [EULAR] good response at least once during the first 6 months of treatment) and duration and rate of drug adherence (referred to as drug survival), as well as predictors thereof.Results. Of 764 patients with PsA, 320 received adalimumab, 260 infliximab, and 184 etanercept. Median drug survival was 2.9 years, and 1-year and 2-year drug survival rates were 70% and 57%, respectively. Clinical parameters that showed improvement over 6 months were the C-reactive protein (CRP) level, Health Assessment Questionnaire score, and 28-joint Disease Activity Score. Male sex, CRP level >10 mg/liter, concomitant methotrexate use, and low patient health visual analog scale score at baseline were associated with longer drug survival. Improvement was achieved by 59%, 45%, 24%, and 54% of patients according to the ACR20, ACR50, ACR70 response criteria and EULAR good response, respectively. A CRP level >10 mg/liter was predictive of the improvement responses (odds ratio [OR] 2.6 for ACR20, OR 3.0 for ACR50, OR 3.6 for ACR70, and OR 2.2 for EULAR good response).Conclusion. In these patients with PsA treated with their first TNF alpha inhibitor in clinical practice, high drug adherence and responder rates were observed. Moreover, increased levels of CRP at baseline were associated with both good treatment responses and continued treatment, which may be of clinical value in selecting the patients most likely to benefit from treatment with TNF alpha inhibitors.