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Rheumatology (Oxford):RA优化治疗:TNFi剂量递减是否疗效好?

2017-11-17 吴星 环球医学

2017年11月,发表在《Rheumatology (Oxford)》的一项由英国科学家进行的原理验证和探索性研究考察了类风湿性关节炎(RA)中,肿瘤坏死因子抑制剂(TNFi)优化治疗中,剂量递减是否反应好。

2017年11月,发表在《Rheumatology (Oxford)》的一项由英国科学家进行的原理验证和探索性研究考察了类风湿性关节炎(RA)中,肿瘤坏死因子抑制剂(TNFi)优化治疗中,剂量递减是否反应好。

目的:接受TNFi的RA患者通常维持初始剂量。RA中肿瘤坏死因子抑制剂优化治疗试验(Optimizing Treatment with Tumour Necrosis Factor Inhibitors in Rheumatoid Arthritis)的目的是评价TNFi剂量递减是否造成临床应答的损失。

方法:研究者纳入使用依那西普或阿达木单抗和DMARD的RA患者,他们DAS28低于3.2超过3个月。初始(0至6个月)患者被随机分配至对照组(TNFi不变)或2个实验组(TNFi剂量递减33%或66%)。随后(6至12月)对照受试者被随机至TNFi剂量递减33%或66%。主要结局为疾病发作(DAS28增加≥0.6,且至少1个额外的关节肿胀)。

结果筛查了244例患者,对103例患者进行随机,97例患者接受了治疗。在0至6个月,对照组发作8/50(16%),剂量递减33%组发作3/26(12%),剂量递减66%组发作6/21(29%)。多变量Cox分析显示,与对照组相比,剂量递减33%组的发作时间没有变化,但剂量递减66%组的发作时间降低(校正风险比2.81,95% CI:0.99,7.94;P=0.051)。对照后,所有使用递减剂量的患者被再次随机化(6至12个月),显示组间差异:剂量递减33%组发作6/48(13%),剂量递减66%组发作14/39(36%)。多变量Cox分析显示,剂量递减66%降低了发作时间(校正风险比3.47,95% CI:1.26,9.58;P=0.016)。

结论:TNFi剂量递减33%对疾病发作没有影响,且似乎在维持缓解和疾病活动度较低的患者中较实用。

原始出处:

Ibrahim F, Lorente-Cánovas B, Doré CJ,et al. Optimizing treatment with tumour necrosis factor inhibitors in rheumatoid arthritis-a proof of principle and exploratory trial: is dose tapering practical in good responders? Rheumatology (Oxford). 2017 Nov 1;56(11):2004-2014. doi: 10.1093/rheumatology/kex315.

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    2017-11-19 snowpeakxu
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    2017-11-19 xiongliangxl

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