Better Retention of Abatacept Is Associated with High Rheumatoid Factor: A Five-Year Follow-Up Study of Patients with Rheumatoid Arthritis
Better Retention of Abatacept Is Associated with High Rheumatoid Factor: A Five-Year Follow-Up Study of Patients with Rheumatoid Arthritis
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DOI：
10.1620/tjem.250.153
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发表时间：
2020-03-01
影响因子：
2.2
通讯作者：
Fujii, Hiroshi
中科院分区：
文献类型：
--
作者：
Okazaki, Soshi;Watanabe, Ryu;Fujii, Hiroshi
近年来，生物疾病修饰抗风湿药物（bDMARDs）彻底改变了类风湿关节炎（RA）的治疗，并为患者提供了更高的机会，实现临床缓解。其中，阿巴西普（abatacept，ABT）通过阻断共刺激信号选择性地抑制T细胞活化，已被报道在控制疾病活动中有效。以前的研究表明，ABT具有高达三年的高留存率，不良事件可耐受;然而，目前尚不清楚这是否能长期维持。在这里，我们进行了一项为期五年的回顾性随访研究，探讨预后因素更好的保留。共入组了2011年5月至2019年7月在大崎市民医院接受ABT治疗的98例患者，包括73例女性患者（74.5%）。采用Kaplan-Meier法估计ABT的留存率。ABT开始的平均年龄为72.1岁。39例患者同时使用甲氨蝶呤，65例患者使用ABT作为一线bDMARD。风湿因子（RF）阳性79例。ABT的1年、3年和5年保留率分别为83.3%、66.2%和62.7%。大约三分之二的停药是由于反应不充分。多因素Logistic回归分析显示，阳性RF与更好的药物保留相关。受试者操作特征分析显示，RF高（>= 45 IU/mL）的患者ABT的留存率更好。总之，ABT在RF阳性患者中显示出较高的留存率。本研究可能提供更好的见解时，选择bDMARD。
Recently, biological disease-modifying antirheumatic drugs (bDMARDs) have revolutionized the treatment of rheumatoid arthritis (RA) and provided patients with a higher chance of achieving clinical remission. Among them, abatacept (ABT), which selectively inhibits T cell activation through blocking costimulation signal, has been reported efficacious in controlling disease activity. Previous studies have shown that ABT has a high retention rate of up to three years with tolerable adverse events; however, it remains unclear whether this is maintained in the longer term. Here we conducted a retrospective five-year follow-up study to explore prognostic factors concerning better retention. In total, 98 patients who were treated with ABT from May 2011 to July 2019 in Osaki Citizen Hospital were enrolled, including 73 female patients (74.5%). The Kaplan-Meier method was used to estimate the retention rate of ABT. The mean age of ABT initiation was 72.1 years. Concomitant methotrexate was prescribed for 39 patients, and ABT was used as the first-line bDMARD for 65 patients. Rheumatoid factor (RF) was positive in 79 patients. One-, three-, and five-year retention rates of ABT were 83.3%, 66.2%, and 62.7%, respectively. Approximately two-thirds of discontinuation resulted from an inadequate response. Multivariate logistic regression analysis revealed that positive RF was associated with better drug retention. Receiver operating characteristics analysis showed that patients with high RF (>= 45 IU/mL) had better retention rate of ABT. In conclusion, ABT shows high retention rate among patients with positive RF. The present study may provide better insights when selecting bDMARDs.