Time and predictors of response to tumour necrosis factor-α blockers in psoriatic arthritis: an analysis of a longitudinal observational cohort
Time and predictors of response to tumour necrosis factor-α blockers in psoriatic arthritis: an analysis of a longitudinal observational cohort
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DOI：
10.1093/rheumatology/keq091
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发表时间：
2010-07-01
期刊：
影响因子：
5.5
通讯作者：
Gladman, Dafna D.
中科院分区：
文献类型：
--
作者：
Eder, Lihi;Chandran, Vinod;Gladman, Dafna D.
目标。在纵向观察队列中，确定PSA患者接受肿瘤坏死因子-α受体阻滞剂治疗的预测因素和有效时间。我们对在一家大型PSA诊所接受前瞻性随访的患者进行了队列分析。治疗反应被定义为活动(压痛和/或肿胀)和肿胀关节计数(SJC)至少改善40%，银屑病面积和严重程度指数(PASI)改善50%。95名患者被纳入分析。在全部患者中，72.6%和77.9%的患者在3个月和12个月时关节活动计数分别有40%的改善。此外，80.5%和87.4%的患者在3个月和12个月时SJC有40%的改善。治疗3个月和12个月后，PASI50分别为54%和60.4%。在17例3个月后SJC未改善40%的患者中，11例(64.7%)在12个月时有反应。在多变量分析中，基线时关节肿胀的数量预测12个月后总活动关节的反应[优势比(OR)1.34；P=0.02]，而既往使用肿瘤坏死因子-α阻滞剂降低了反应的几率(OR 0.05；P=0.01)。肿瘤坏死因子-α阻滞剂对大多数PSA患者有效，大多数患者在治疗后3个月内有反应。相当大比例的早期无反应者将对治疗有延迟反应。基线时较高的SJC和先前未使用肿瘤坏死因子-α受体阻滞剂可预测疗效。
Objective. To determine predictors and time to response to treatment with TNF-alpha blockers in patients with PsA in a longitudinal observational cohort.Methods. We performed a cohort analysis of patients who were followed prospectively in a large PsA clinic. Response to treatment was defined as an improvement of at least 40% in active (tender and/or swollen) and swollen joint count (SJC) and 50% improvement in the Psoriasis Area and Severity Index (PASI) score.Results. Ninety-five patients were included in the analysis. Of the total patients, 72.6 and 77.9% demonstrated 40% improvement in active joint counts at 3 and 12 months, respectively. Also, 80.5 and 87.4% of the patients showed 40% improvement in SJC at 3 and 12 months, respectively. A PASI50 was achieved by 54 and 60.4% after 3 and 12 months of treatment, respectively. Of 17 patients who did not achieve 40% improvement in total SJC at 3 months, 11 (64.7%) responded at 12 months. In multivariate analysis, the number of swollen joints at baseline predicted response of total active joints at 12 months [odds ratio (OR) 1.34; P = 0.02], whereas past use of TNF-alpha blocker decreased odds of response (OR 0.05; P = 0.01).Conclusion. TNF-alpha blockers are effective in most PsA patients with the majority responding within 3 months of treatment. A significant proportion of the early non-responders will have a delayed response to treatment. Higher SJC at baseline and no prior use of TNF-alpha blockers predict response.