Association of disease activity with acute exacerbation of interstitial lung disease during tocilizumab treatment in patients with rheumatoid arthritis: a retrospective, case-control study
Association of disease activity with acute exacerbation of interstitial lung disease during tocilizumab treatment in patients with rheumatoid arthritis: a retrospective, case-control study
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DOI：
10.1007/s00296-016-3478-3
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发表时间：
2016-06-01
影响因子：
4
通讯作者：
Takeuchi, Tsutomu
中科院分区：
文献类型：
--
作者：
Akiyama, Mitsuhiro;Kaneko, Yuko;Takeuchi, Tsutomu
该研究的目的是确定tocilizumab治疗类风湿关节炎（RA）患者间质性肺疾病（ILD）急性加重的危险因素。这是一项回顾性病例对照研究。我们回顾了395例连续接受tocilizumab治疗的RA患者。首先，我们根据胸片或高分辨率计算机断层扫描评估的存在（RA-ILD）或不存在ILD（非ILD）对患者进行分类，并比较他们与RA-ILD相关的特征。随后，针对RA-ILD患者，我们评估了他们的基线特征和临床病程，比较了有急性加重的患者和没有急性加重的患者。通过对78例ILD患者和317例非ILD患者进行多因素分析，以下因素被确定为RA-ILD的相关因素：60岁及以上（or 4.5, 95% CI 2.2-9.4, P < 0.0001）、吸烟习惯（or 2.9, 95% CI 1.5-5.5, P = 0.002）和高类风湿因子水平（or 2.8, 95% CI 1.4-5.5, P = 0.002）。78例RA-ILD患者中，6例在托珠单抗治疗期间出现急性加重。从开始托珠单抗治疗到急性加重发生的中位持续时间为48周。虽然急性加重组和非急性加重组之间的基线特征没有差异，但急性加重患者在24周时的临床疾病活动指数（CDAI）明显更高（20.8比6.2,P = 0.019）。单因素分析显示，24周时CDAI bbb10是急性加重的危险因素（OR 4.7, 95% CI 2.1-10.4, P = 0.02）。托珠单抗治疗期间不受控制的关节炎活动可能与RA- ild的急性加重有关，这表明治疗后疾病活动监测不仅对RA本身很重要，而且对RA- ild也很重要。
The objective of the study was to identify risk factors for acute exacerbation of interstitial lung disease (ILD) during tocilizumab treatment in patients with rheumatoid arthritis (RA). This is a retrospective, case-control study. We reviewed 395 consecutive RA patients who received tocilizumab. First, we divided the patients according to the presence (RA-ILD) or absence of ILD (non-ILD) assessed by chest X-ray or high-resolution computed tomography, and compared them for characteristics relevant to RA-ILD. Subsequently, focusing on the patients with RA-ILD, we assessed their baseline characteristics and clinical courses comparing patients with acute exacerbation to those without. Comparing 78 with ILD and 317 without ILD, the following were identified as factors related to RA-ILD on multivariate analysis: age 60 years or older (OR 4.5, 95 % CI 2.2-9.4, P < 0.0001), smoking habit (OR 2.9, 95 % CI 1.5-5.5, P = 0.002), and high rheumatoid factor levels (OR 2.8, 95 % CI 1.4-5.5, P = 0.002). Of 78 RA-ILD patients, six developed acute exacerbation during tocilizumab treatment. The median duration between the initiation of tocilizumab treatment and the acute exacerbation occurrence was 48 weeks. While baseline characteristics did not differ between acute exacerbation and non-acute exacerbation groups, patients experiencing acute exacerbation had significantly higher Clinical Disease Activity Index (CDAI) at 24 weeks (20.8 vs. 6.2, P = 0.019). Univariate analysis showed that CDAI > 10 at 24 weeks was a risk factor for acute exacerbation (OR 4.7, 95 % CI 2.1-10.4, P = 0.02). Uncontrolled arthritis activity during tocilizumab treatment may be associated with acute exacerbation of RA-ILD, suggesting post-treatment monitoring of disease activity is important not only with respect to RA itself but also for RA-ILD.