与银屑病关节炎生物制剂和合成靶向疗法无效有关的转换:一项真实生活比较研究。

IF 3.4 2区 医学 Q2 RHEUMATOLOGY
Therapeutic Advances in Musculoskeletal Disease Pub Date : 2024-08-31 eCollection Date: 2024-01-01 DOI:10.1177/1759720X241273083
Dalifer Freites-Nuñez, Leticia Leon, Esther Toledano, Gloria Candelas, Cristina Martinez, Maria Rodriguez-Laguna, Daniel Rubio, Benjamin Fernandez-Gutierrez, Lydia Abasolo
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引用次数: 0

摘要

背景:对于治疗失败的银屑病关节炎(PsA)患者来说,转换疗法是一种推荐策略;然而,包括真实数据在内的研究却很少:目的:评估PsA患者因疗效不佳而在生物制剂和靶向合成改善病情抗风湿药(b/tsDMARDs)之间转换治疗方案的发生率(IR),并比较不同b/tsDMARDs群体因疗效不佳而转换治疗方案的风险:设计:一项纵向回顾性研究,时间跨度为2007年至2022年,研究对象是在风湿病门诊接受b/tsDMARDs治疗的PsA患者:主要研究结果是因疗效不佳而更换b/tsDMARDs。自变量是随访期间的b/tsDMARDs暴露。作为协变量,考虑了临床、治疗相关和社会人口学变量。采用生存技术估算了每 100 例患者*年因疗效不佳而转药的 IR 值和 95% 的置信区间(95% CI)。进行了Cox多变量回归分析,以评估因疗效不佳而更换b/tsDMARDs的风险,以危险比(HR)和95% CI表示:共纳入141名患者,随访时间为893.09个患者*年。其中52.48%为50多岁的女性。共记录了 262 个疗程。在研究期间,56 名患者出现了 121 次换药,103 次无效(IR:11.53 (9.51-13.98))。肿瘤坏死因子-α抑制剂(TNFi)的IR最低。在二变量分析中,与 TNFi 相比,所有 b/tsDMARDs 的转药风险都更高(HR:抗-L-17 vs TNFi:2.26(1.17-4.36);其他 vs TNFi:3.21(1.59-6.45));然而,在对协变量进行调整后,这一统计显著性在多变量分析中不再存在。尽管如此,最终模型在以下变量中仍具有统计学意义:性别、临床症状、处方年份、疗程、糖皮质激素和柳氮磺胺吡啶:在这项研究中,我们没有发现不同组别的 b/tsDMARDs 因疗效不佳而更换治疗方案的比例存在差异。其他伴随治疗、社会人口学和临床变量被认为是因疗效不佳而换药的风险因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Switching related to inefficacy in biologics and targeted synthetic therapies for psoriatic arthritis: a comparative real-life study.

Background: Switching between therapies is a recommended strategy for psoriatic arthritis (PsA) patients who experience treatment failure; however, studies including real-life data are scarce.

Objectives: To assess the incidence rate (IR) of switching between biologics and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) due to inefficacy in PsA, and to compare the risk of switching due to inefficacy across different b/tsDMARDs groups.

Design: A longitudinal retrospective study, spanning from 2007 to 2022, was conducted on patients with PsA treated with b/tsDMARDs at an outpatient rheumatology clinic.

Methods: The primary outcome was switching between b/tsDMARDs due to inefficacy. The independent variable was the exposure to b/tsDMARDs during follow-up. As covariates, clinical, treatment-related, and sociodemographic variables were considered. Survival techniques were run to estimate the IR of switching due to inefficacy per 100 patients*year and confidence interval at 95% (95% CI). Cox multivariate regression analyses were run to assess the risk of b/tsDMARDs switching due to inefficacy, expressed as hazard ratio (HR) and 95% CI.

Results: In all, 141 patients were included, with 893.09 patients*year follow-ups. 52.48% of them were females in their fifties. In total, 262 courses of treatment were recorded. During the study period, 56 patients presented 121 switches and 103 related to inefficacy (IR: 11.53 (9.51-13.98)). Tumor necrosis factor-alpha inhibitors (TNFi) showed the lowest IR. In the bivariate analysis, all b/tsDMARDs had more risk of switching compared to TNFi (HR: anti-lL-17 vs TNFi: 2.26 (1.17-4.36); others vs TNFi: 3.21 (1.59-6.45)); however, this statistical significance was no longer present in the multivariate analysis once adjustments were made for the covariates. Still, the final model achieved statistical significance in the following variables: gender, clinical symptoms, prescription year, therapy courses, glucocorticoids, and sulfasalazine.

Conclusion: In this study, we did not find differences in the rate of switching due to inefficacy among different groups of b/tsDMARDs. Other concomitant treatments, sociodemographic, and clinical variables were identified as risk factors for switching due to inefficacy.

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来源期刊
CiteScore
6.80
自引率
4.80%
发文量
132
审稿时长
18 weeks
期刊介绍: Therapeutic Advances in Musculoskeletal Disease delivers the highest quality peer-reviewed articles, reviews, and scholarly comment on pioneering efforts and innovative studies across all areas of musculoskeletal disease.
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