Impact of concomitant use of DMARDs on the persistence with anti-TNF therapies in patients with rheumatoid arthritis: results from the British Society for Rheumatology Biologics Register
Impact of concomitant use of DMARDs on the persistence with anti-TNF therapies in patients with rheumatoid arthritis: results from the British Society for Rheumatology Biologics Register
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DOI：
10.1136/ard.2010.139774
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发表时间：
2011-04-01
影响因子：
27.4
通讯作者：
Hyrich, Kimme L.
中科院分区：
文献类型：
--
作者：
Soliman, Moetaza M.;Ashcroft, Darren M.;Hyrich, Kimme L.
目的评价不同的抗风湿药物（DMARDs）对抗肿瘤坏死因子（TNF）持续性的影响方法该分析包括10396例在英国风湿病学会生物制剂注册处注册的RA患者，这是一项前瞻性观察性队列研究，开始首次抗TNF治疗并在基线时接受以下DMARD治疗之一：无DMARD组3339例，甲氨蝶呤组4418例，来氟米特组610例，柳氮磺胺吡啶组308例，MTX+ SSZ组902例，MTX+ HCQ（n=401）或MTX+SSZ+HCQ（n=418）。Kaplan-Meier生存分析用于研究每个DMARD亚组中抗TNF治疗长达5年的持续性。采用多变量考克斯比例风险模型，按使用的抗TNF抗体和起始年份分层，并对一些潜在的混杂因素进行调整，以比较总体治疗持续性和每个DMARD亚组之间的停药原因，结果首次抗TNF治疗的1年药物生存率（95%CI）为71%（71%至72%），但5年时降至42%（41%至43%）。与MTX相比，没有接受DMARD，LEF或SSZ的患者更有可能停止他们的第一次抗TNF治疗，而接受MTX与其他DMARDs. Conclusions联合治疗的患者表现出更好的治疗持久性，这些结果支持继续使用的背景DMARD组合，其中包括MTX。在开始抗TNF治疗时，应考虑停止LEF和SSZ单药治疗，SSZ+ETN联合治疗可能除外。
Objective To evaluate the effect of different concomitant disease modifying antirheumatic drugs (DMARDs) on the persistence with antitumour necrosis factor (anti-TNF) therapies in patients with rheumatoid arthritis (RA).Method This analysis included 10 396 patients with RA registered with the British Society for Rheumatology Biologics Register, a prospective observational cohort study, who were starting their first anti-TNF therapy and were receiving one of the following DMARD treatments at baseline: no DMARD (n=3339), methotrexate (MTX) (n=4418), leflunomide (LEF) (n=610), sulfasalazine (SSZ) (n=308), MTX+SSZ (n=902), MTX+ hydroxychloroquine (HCQ) (n=401) or MTX+SSZ+HCQ (n=418). Kaplan-Meier survival analysis was used to study the persistence with anti-TNF therapy in each DMARD subgroup up to 5 years. Multivariate Cox proportional hazard models, stratified by anti-TNF used and start year and adjusted for a number of potential confounders, were used to compare treatment persistence overall and according to the reason for discontinuation between each of the DMARD subgroups, using MTX as reference.Results One-year drug survival (95% CI) for the first anti-TNF therapy was 71% (71% to 72%) but this dropped to 42% (41% to 43%) at 5 years. Compared with MTX, patients receiving no DMARD, LEF or SSZ were more likely to discontinue their first anti-TNF therapy while patients receiving MTX in combination with other DMARDs showed better treatment persistence.Conclusions These results support the continued use of background DMARD combinations which include MTX. Consideration should be given to the discontinuation of LEF and SSZ monotherapy at the time anti-TNF therapies are started, with the possible exception of the SSZ+ETN combination.