Treatment failure in giant cell arteritis.
Treatment failure in giant cell arteritis.
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DOI：
10.1136/annrheumdis-2021-220347
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发表时间：
2021-11
影响因子：
27.4
通讯作者：
Stone JH
中科院分区：
文献类型：
--
作者：
Unizony SH;Bao M;Han J;Luder Y;Pavlov A;Stone JH
确定接受托珠单抗联合糖皮质激素治疗的巨细胞动脉炎 (GCA) 患者和仅接受糖皮质激素治疗的巨细胞动脉炎 (GCA) 患者治疗失败的预测因子。巨细胞动脉炎 Actemra 试验的事后分析，包括 250 名患者，每周接受托珠单抗加 26 周泼尼松逐渐减量治疗 (n=100)，每隔一周接受托珠单抗加 26 周泼尼松逐渐减量治疗 (n=49) 或安慰剂加 26 周 (n=50) 或 52 周 (n=51) 泼尼松逐渐减量治疗。意向治疗人群。该分析的响应者是在第 52 周保持缓解（无 GCA 体征/症状，无红细胞沉降率升高）的患者。治疗失败定义为无法在第 12 周实现缓解或在第 12 周至第 52 周之间复发。单变量和多变量分析中研究的预测因素包括患者特征、疾病相关和治疗相关因素以及患者报告的结果 (PRO)。 149 名患者接受托珠单抗加泼尼松 (TCZ/PDN) 治疗，101 名患者接受安慰剂加泼尼松 (PBO+PDN) 治疗。调整混杂因素后，TCZ/PDN 组治疗失败的可能性显着低于 PBO/PDN 组（OR，0.2；95%CI，0.1 至 0.3；p<0.0001）。 PBO/PDN 组中女性治疗失败的风险显着高于男性（OR，5.2；95%CI，1.6 至 17.2；p=0.007），但 TCZ/PDN 组则不然。 TCZ/PDN 组治疗失败的预测因素包括基线泼尼松剂量较低和基线 PRO 较差。 GCA 治疗失败的最强危险因素是单独使用泼尼松治疗和女性。较低的泼尼松起始剂量和 PRO 受损与托珠单抗无反应有关。 NCT01791153。
Identify predictors of treatment failure in patients with giant cell arteritis (GCA) receiving tocilizumab in combination with glucocorticoids and in patients with GCA receiving only glucocorticoids. Posthoc analysis of the Giant-Cell Arteritis Actemra trial including 250 patients who received tocilizumab every week plus a 26-week prednisone taper (n=100), tocilizumab every-other-week plus a 26-week prednisone taper (n=49) or placebo plus a 26-week (n=50) or 52-week (n=51) prednisone taper in the intention-to-treat population. Responders for this analysis were patients who maintained remission (no GCA signs/symptoms and no erythrocyte sedimentation rate elevation) through week 52. Treatment failure was defined as inability to achieve remission by week 12 or relapse between weeks 12 and 52. Predictors investigated in univariate and multivariable analyses included patient characteristics, disease-related and treatment-related factors and patient-reported outcomes (PROs). 149 patients received tocilizumab plus prednisone (TCZ/PDN) and 101 received placebo plus prednisone (PBO+PDN). After adjustment for confounders, treatment failure was significantly less likely in the TCZ/PDN group than the PBO/PDN group (OR, 0.2; 95% CI, 0.1 to 0.3; p<0.0001). Risk for treatment failure was significantly higher in women than men in the PBO/PDN group (OR, 5.2; 95% CI, 1.6 to 17.2; p=0.007) but not in the TCZ/PDN group. Predictors of treatment failure in the TCZ/PDN group included lower baseline prednisone doses and worse PROs at baseline. The strongest risk factors for treatment failure in GCA are treatment with prednisone alone and female sex. Lower starting prednisone doses and impaired PROs are associated with failure to respond to tocilizumab. NCT01791153.
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影响因子：
158.5
作者：
Stone, J. H.;Tuckwell, K.;Collinson, N.
通讯作者：
Collinson, N.
影响因子：
1.6
作者：
Restuccia, Giovanna;Boiardi, Luigi;Salvarani, Carlo
通讯作者：
Salvarani, Carlo
影响因子：
13.3
作者：
Stone, John H.;Tuckwell, Katie;Collinson, Neil
通讯作者：
Collinson, Neil
影响因子：
4.9
作者：
Unizony S;McCulley TJ;Spiera R;Pei J;Sidiropoulos PN;Best JH;Birchwood C;Pavlov A;Stone JH
通讯作者：
Stone JH
影响因子：
4.9
作者：
Strand, Vibeke;Dimonaco, Sophie;Stone, John H.
通讯作者：
Stone, John H.