Anti-tumour necrosis factor therapy in patients with refractory Takayasu arteritis: long-term follow-up
Anti-tumour necrosis factor therapy in patients with refractory Takayasu arteritis: long-term follow-up
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DOI：
10.1136/ard.2008.093260
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发表时间：
2008-11-01
影响因子：
27.4
通讯作者：
Hoffman, G. S.
中科院分区：
文献类型：
--
作者：
Molloy, E. S.;Langford, C. A.;Hoffman, G. S.
方法：对25例难治性大动脉炎患者进行单中心回顾性研究。结果：用英夫利昔单抗(IFX)或依那西普(ETA)治疗难治性TAK患者长达7年；IFX组21例(中位28个月)，ETA组9例(中位28个月)；ETA组5例(中位28个月)。在抗肿瘤坏死因子治疗后，15名患者(60%)获得缓解，强的松停用，另有7名患者(28%)成功地减少到每天10毫克以下。在18例在抗肿瘤坏死因子治疗的同时接受其他免疫抑制剂治疗的患者中，9例(50%)可以逐渐减少或停止使用额外的药物。在最初实现稳定缓解的四名患者中出现了较大的复发。4例患者发生不良事件，包括1例机会性感染和1例乳腺癌。结论：在这组难治性TAK患者中，抗肿瘤坏死因子治疗与大多数患者的缓解有关，有助于减少或停用强的松和其他免疫抑制治疗。这些发现加强了在TAK中进行抗肿瘤坏死因子治疗的随机对照试验的理论基础。
Objective: To assess the efficacy of anti-tumour necrosis factor (TNF) therapy to induce remission in patients with Takayasu arteritis (TAK) refractory to other immunosuppressive therapies.Methods: Retrospective single-centre study of 25 patients with refractory TAK.Results: Patients were treated with infliximab (IFX) or etanercept (ETA) for up to 7 years; 21 with IFX (median 28 months (range 2-84)) and 9 with ETA (median 28 months (range 4-82)); 5 patients initially treated with ETA subsequently switched to IFX. Following anti-TNF therapy, remission was achieved and prednisone was discontinued in 15 patients (60%) and successfully tapered below 10 mg/day in an additional 7 patients (28%). Of 18 patients treated with other immunosuppressive agents concurrent with anti-TNF therapy, 9 (50%) could taper or discontinue the additional agent. Major relapses occurred in four patients that initially achieved stable remission. Four patients suffered adverse events, including one with opportunistic infections and one with breast cancer.Conclusions: In this group of patients with refractory TAK, anti-TNF therapy was associated with remission in a majority of patients, facilitating dose reduction or discontinuation of prednisone and other immunosuppressive therapy. These findings strengthen the rationale for the conducting of a randomised controlled trial of anti-TNF therapy in TAK.