類風溼關節炎(RA)患者接受聯合治療

類風溼關節炎(RA)患者接受聯合治療達到病情緩解或低疾病活動度(LDA)後 繼續使用TNFi單一藥物治療

類風溼關節炎(RA)患者接受聯合治療

達到病情緩解或低疾病活動度(LDA)後

繼續使用TNFi單一藥物治療

背 景

TNFi和csDMARDs聯合療法是中度至重度RA患者的標準療法。

目 的

預估接受TNFi+csDMARD聯合療法達到病情緩解/LDA後，停用csDMARD的RA患者中，繼續使用依那西普 (ETN)或其他TNFi單一藥物的情況。

方 法

研究分析了2001年10月1日至2017年8月31日之間北美風溼病研究者協會(CORRONA) 登記的RA患者的資料。所有患者需接受TNFi+csDMARD聯合療法，達到病情緩解/LDA後停用csDMARD（指標日期）。單獨分析ETN(包含腫瘤壞死因子受體和人體IgG1 Fc的融合蛋白)以及其他TNFi療法（單克隆抗體：阿達木單抗、妥珠單抗、欣普尼、英夫利昔）。分析結果為在6個月（初步分析）和12個月後索引繼續服用TNFi單一藥物、停用TNFi、轉用其他生物或csDMARD單一藥物或增加csDMARD治療（以接受聯合療法）的患者比例。

結 果

研究分析了617位患者的資料（182位使用ETN, 435位使用其他TNFi），平均年齡（標準差）為57.4 (13.3) 歲，73%為男性。停用csDMARD前病情緩解/LDA平均時間為17.0 (24.3)個月。6個月時單一藥物治療的患者中，56%使用ETN，45%使用其他TNFi（見表1）。單一藥物治療≥6個月的患者中，ETN的平均持續時間 (SD) 為28.2 (22.1) 個月，其他TNFi為27.8 (23.3) 個月。12個月時，46%的患者持續使用ENT，33%持續使用其他TNFi。持續治療 ≥12的患者中，使用ENT單一藥物的平均持續時間（SD）為35.9 (22.6)個月，其他TNFi單一藥物為39.3 (24.4)個月。在指標日期前6個月內達到病情緩解/LDA的患者組中，在6個月時繼續使用ENT單一藥物的比例為60%，而使用其他TNFi的比例為42%。

結 論

對於緩解期或LDA的患者使用ETN或其他TNFi單獨治療可作為一種方案；在停用csDMARD之後仍有超過50%的患者使用ETN治療超過6個月。

原 文

FRI0112 Persistence on tumour necrosis factor inhibitor (TNFI) monotherapy after achieving remission or low disease activity (LDA) on combination therapy among patients with rheumatoid arthritis (RA)

Background

Combination therapy with TNFis and conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) is standard for moderate to severe RA.

Objectives

To estimate persistence with etanercept (ETN) or other TNFi monotherapy among RA patients who achieved remission/LDA on combination TNFi +csDMARD therapy and then discontinued the csDMARD.

Methods

Data from RA patients in the Corrona registry during 10/1/2001–8/31/2017 were analysed. All patients had to be treated with TNFi +csDMARD combination therapy and to have reached Clinical Disease Activity Index remission/LDA and then discontinue the csDMARD (index date). ETN (fusion protein comprising TNF receptor and human IgG1 Fc) and other TNFi therapies (monoclonal antibodies: adalimumab, certolizumab pegol, golimumab, and infliximab) were analysed separately. Outcomes were percentages of patients persistent on index TNFi monotherapy, discontinued index TNFi, switched (to another biologic or to csDMARD monotherapy), or added csDMARD therapy (to receive combination therapy) at 6 months (primary analysis) and 12 months post-index.

Results

Data from 617 patients were analysed (182 ETN, 435 other TNFi); mean age (standard deviation ) was 57.4 (13.3) years, 73% were female. Mean time (SD) in remission/LDA before csDMARD discontinuation was 17.0 (24.3) months. Rates of monotherapy persistence at 6 months were 56% for ETN and 45% for other TNFi (table 1). Patients with ≥6 month persistence on monotherapy had mean duration (SD) of 28.2 (22.1) months on ETN monotherapy or 27.8 (23.3) months on other TNFi monotherapy. Rates of persistence for all patients at 12 months were 46% for ETN and 33% for other TNFi. Patients with ≥12 month persistence had mean duration (SD) of 35.9 (22.6) months on ETN monotherapy or 39.3 (24.4) months on other TNFi monotherapy. For a subset of patients with <6 months in remission/LDA before index date (44% of patients), rates of monotherapy persistence at 6 months were 60% for ETN and 42% for other TNFi.

Conclusions

Monotherapy with ETN or other TNFi is an option for patients in remission/LDA;>50% of patients on ETN remained on monotherapy 6 months after discontinuing their csDMARD.

文章出處：

D.A. Pappas,H.J. Litman, T. Lesperance, S. Rebello, E. Karis, G. Kricorian, W. Hua, N. Accortt. Annals of Rheumatic Diseases. FRIDAY, 15 JUNE 2018

https://ard.bmj.com/content/77/Suppl_2/600.2