Switching between TNF inhibitors in psoriatic arthritis: data from the NOR-DMARD study
Switching between TNF inhibitors in psoriatic arthritis: data from the NOR-DMARD study
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DOI：
10.1136/annrheumdis-2012-203018
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发表时间：
2013-11-01
影响因子：
27.4
通讯作者：
Kvien, Tore K.
中科院分区：
文献类型：
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作者：
Fagerli, Karen Minde;Lie, Elisabeth;Kvien, Tore K.
背景肿瘤坏死因子抑制剂（TNFi）对银屑病关节炎（PsA）患者有效，但有些患者对第一种TNFi无反应或不耐受，而改用不同的TNFi。支持这种做法的证据是有限的，我们想调查切换到第二TNFi.Material和方法的有效性从纵向观察研究（LOS），我们选择了PsA患者开始他们的第一个TNFi，并确定患者切换到第二TNFi（开关）。结果接受第二次TNFi的转换者（n=95）与非转换者（n=344）相比，有显著较差的反应（ACR 50反应：22.5%vs40.0%，DAS 28缓解：28.2%vs54.1%）。有一个趋势，对第二个TNFi的反应较差相比，第一个TNFi转换器内。估计3年的药物生存率为36%的第二TNFi相比，57%的第一TNFi overall.Conclusions 20-40%的患者有一个失败的TNFi后，在这个LOS第二TNFi的反应。这一观察结果强调了在PsA患者中需要使用除TNF抑制以外的其他作用机制进行治疗。
Background Tumour necrosis factor inhibitors (TNFi) are efficacious in patients with psoriatic arthritis (PsA), but some patients do not respond or do not tolerate their first TNFi, and are switched to a different TNFi. Evidence supporting this practice is limited, and we wanted to investigate the effectiveness of switching to a second TNFi.Material and methods From a longitudinal observational study (LOS) we selected patients with PsA who were starting their first TNFi, and identified patients who had switched to a second TNFi (switchers'). Three-month responses and 3-year drug-survival were compared between switchers and non-switchers, and within switchers.Results Switchers (n=95) receiving their second TNFi had significantly poorer responses compared with non-switchers (n=344) (ACR50 response: 22.5% vs 40.0%, DAS28 remission: 28.2% vs 54.1%). There was a trend towards poorer responses to the second TNFi compared with the first TNFi within switchers. Estimated 3-year drug-survival was 36% for the second TNFi compared with 57% for the first TNFi overall.Conclusions 20-40% of patients had a response on a second TNFi after having failed one TNFi in this LOS. This observation highlights the need for treatments with other mechanisms of action than TNF inhibition in patients with PsA.