Dose escalation of the anti-TNF-α agents in patients with rheumatoid arthritis.: A systematic review
Dose escalation of the anti-TNF-α agents in patients with rheumatoid arthritis.: A systematic review
复制标题
DOI：
10.1093/rheumatology/kel326
复制
发表时间：
2007-03-01
期刊：
影响因子：
5.5
通讯作者：
Toyos, J.
中科院分区：
文献类型：
--
作者：
Ariza-Ariza, R.;Navarro-Sarabia, F.;Toyos, J.
Objective.估计类风湿关节炎（RA）患者中需要剂量递增的抗肿瘤坏死因子（抗TNF）患者的比例。科学文献的系统综述。考虑了英夫利西单抗、依那西普和阿达木单抗治疗RA的研究。主要结局是需要剂量递增的患者比例。当可用时，评估美国大学流变学（ACR）和疾病活动性评分（DAS）升级后的反应。从1801篇参考文献中，纳入了16项研究，8510例患者。在所有英夫利西单抗患者中，53.7%接受了剂量递增。44%的英夫利西单抗患者出现剂量增加，8.3%的患者出现频率增加。在一项研究中，剂量递增的ACR 20应答范围为27 - 36%，DAS 28从5.2改善至4.5，在另一项研究中从4.1改善至3.7。在依那西普患者中，17.5%的患者剂量增加，但平均剂量变化无统计学意义。结论。剂量递增在接受英夫利西单抗治疗的患者中很常见，而依那西普的频率较低。在一部分患者中，剂量递增似乎有效。现有研究的设计和证据水平限制了结论的强度。
Objective. To estimate the proportion of rheumatoid arthritis (RA) patients on anti-tumour necrosis factor (anti-TNF) who require dose escalation.Methods. Systematic review of the scientific literature. Infliximab, etanercept and adalimumab studies in RA were considered. Primary outcome was the proportion of patients requiring dose escalation. American College Rheumatology (ACR) and Disease activity score (DAS) responses post-escalation were assessed when available.Results. From 1801 references, 16 studies with 8510 patients were included. Of all the infliximab patients, 53.7% underwent dose escalation. Fourty-four per cent of the infliximab patients experienced dose increase and 8.3%, frequency increase. The ACR20 response to dose escalation ranged from 27 to 36% and DAS28 improved from 5.2 to 4.5 in one study and from 4.1 to 3.7 in another. Of the etanercept patients, 17.5% experienced a dose increase but changes on the mean dose were not statistically significant.Conclusions. Dose escalation is common in patients treated with infliximab, and less frequent with etanercept. In a proportion of patients, the dose escalation seems effective. The design and evidence level of the available studies limit the strength of the conclusions.