Is background methotrexate advantageous in extending TNF inhibitor drug survival in elderly patients with rheumatoid arthritis? An analysis of the British Society for Rheumatology Biologics Register
Is background methotrexate advantageous in extending TNF inhibitor drug survival in elderly patients with rheumatoid arthritis? An analysis of the British Society for Rheumatology Biologics Register
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DOI：
10.1093/rheumatology/kez671
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发表时间：
2020-09-01
期刊：
影响因子：
5.5
通讯作者：
Galloway, James B.
中科院分区：
文献类型：
--
作者：
Bechman, Katie;Oke, Anuoluwapo;Galloway, James B.
Objective.评估单药治疗与MTX联合治疗老年RA患者的药物生存率。纳入了来自英国风湿病学会生物制剂注册中心（一个前瞻性观察队列）的患者，这些患者为生物制剂初治患者，并开始使用第一种TNF抑制剂（TNFi）。该队列根据年龄分层：= 75岁。Cox比例风险模型比较了TNFi单药治疗与TNFi MTX联合治疗的患者因（i）任何原因、（ii）无效和（iii）不良事件而停用TNFi的风险。该分析包括15700例患者。95%为≥ 75岁队列。52%的患者在随访期间停止了TNFi治疗。与年轻患者相比，≥ 75例患者的治疗持续性更高，由于无效而停药的人数少于不良事件。这可能反映了更大的毒性倾向，但也可能反映了与免疫衰老相关的免疫原性下降。
Objective. To evaluate drug survival with monotherapy compared with combination therapy with MTX in RA older adults.Methods. Patients from the British Society for Rheumatology Biologics Register, a prospective observational cohort, who were biologic naive and commencing their first TNF inhibitors (TNFi) were included. The cohort was stratified according to age: = 75. Cox-proportional hazards models compared the risk of TNFi discontinuation from (i) any-cause, (ii) inefficacy and (iii) adverse events, between patients prescribed TNFi-monotherapy compared with TNFi MTX combination.Results. The analysis included 15 700 patients. Ninety-five percent were = 75 cohort. Fifty-two percent of patients discontinued TNFi therapy during the follow-up period. Persistence with therapy was higher in the = 75 have fewer discontinuations due to inefficacy than adverse events compared with younger patients. This likely reflects greater disposition to toxicity but perhaps also a decline in immunogenicity associated with immunosenescence.