The effectiveness of anti-tumor necrosis factor therapy in preventing progressive radiographic joint damage in rheumatoid arthritis - A population-based study
The effectiveness of anti-tumor necrosis factor therapy in preventing progressive radiographic joint damage in rheumatoid arthritis - A population-based study
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DOI：
10.1002/art.21491
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发表时间：
2006-01-01
影响因子：
--
通讯作者：
Guerne, PA
中科院分区：
文献类型：
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作者：
Finckh, A;Simard, JF;Guerne, PA
目标。在以人群为基础的队列中，比较3种治疗策略在预防进行性关节损伤方面的有效性。这3种策略分别是英夫利昔单抗联合抗风湿药物(DMARDS)、依那西普联合DMARDS和单独使用依那西普。我们使用连续X线片对所有接受英夫利昔单抗或依那西普治疗10个月的患者进行评估。对纵向数据进行多元回归分析，并对潜在的混杂因素进行调整，对侵蚀进展率和关节间隙狭窄(JSN)进行分析。共有372名接受抗肿瘤坏死因子(TNF)治疗的患者符合纳入标准。除了如预期的那样，更多的患者正在接受英夫利昔单抗的联合治疗外，分配到这三种策略的患者的基线特征没有显著差异。英夫利昔单抗联合DMARDS在控制侵蚀进展方面明显优于单用依那西普(P<；0.001)，但两种联合治疗策略的疗效相似(P=0.07)。英夫利昔单抗联合DMARDS在控制进展性JSN方面也比单用依那西普(P=0.04)或依那西普+DMARDS(P=0.02)更有效。联合应用抗肿瘤坏死因子药物(英夫利昔单抗或依那西普)联合应用DNLARD较单用依那西普更有效(P=0.045)。当与传统的DNLARD联合使用时，依那西普和英夫利昔单抗似乎对进行性结构关节损害提供了类似的保护，并且与这两种药物中的任何一种联合治疗似乎比单独使用依那西普更有效。
Objective. To compare the effectiveness of 3 therapeutic strategies in preventing progressive joint damage, in a population-based cohort. The 3 strategies were infliximab with concomitant disease-modifying antirheumatic drugs (DMARDs), etanercept with concomitant DMARDs, and etanercept alone.Methods. We used sequential radiographs to assess all patients who were treated with infliximab or etanercept for > 10 months. The rates of erosion progression and joint space narrowing (JSN) were analyzed using multivariate regression models for longitudinal data, with adjustment for potential confounders.Results. A total of 372 patients treated with anti-tumor necrosis factor (TNF) therapies met the inclusion criteria. The baseline characteristics of the patients assigned to the 3 strategies were not significantly different, except that, as expected, more patients were receiving combination therapy with infliximab. The combination of infliximab plus DMARDs was significantly more effective than etanercept alone for controlling erosion progression (P < 0.001), but the effectiveness of the 2 combination-treatment strategies was similar (P = 0.07). The combination of infliximab plus DMARDs was also more effective at controlling progressive JSN compared with etanercept alone (P = 0.04) or etanercept plus DMARDs (P = 0.02). Treatment with anti-TNF agents (infliximab or etanercept) plus concomitant DNLARDs was more effective than treatment with etanercept alone for controlling erosion progression (P = 0.045).Conclusion. When combined with traditional DNLARDs, both etanercept and infliximab appear to offer similar protection against progressive structural joint damage, and combination therapy with either of these agents appears to be more effective than treatment with etanercept alone.