类风湿因子对类风湿关节炎患者TNF抑制剂疗效的影响。

IF 2.9 3区医学 Q2 RHEUMATOLOGY

Rheumatology and Therapy Pub Date : 2025-08-01 Epub Date: 2025-05-16 DOI:10.1007/s40744-025-00769-3

Atsushi Nagayasu, Yusuke Miyazaki, Koshiro Sonomoto, Satoshi Kubo, Ippei Miyagawa, Ayako Yamaguchi, Hiroaki Tanaka, Yasuyuki Todoroki, Masanobu Ueno, Takafumi Aritomi, Yuya Fujita, Hidenori Sakai, Katsunori Suzuki, Shingo Nakayamada, Yoshiya Tanaka

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引用次数: 0

摘要

虽然肿瘤坏死因子抑制剂（TNFi）在类风湿因子（RF）高的类风湿关节炎（RA）患者中的疗效降低，但缺乏Fc部分的certolizumab pegol （CZP）可能不受影响。本研究旨在比较CZP与含fc的TNFi，并探讨RF水平是否会影响CZP在RA患者中的疗效。方法：这项多中心回顾性研究纳入了接受TNFi联合甲氨蝶呤（MTX）治疗的RA患者（n = 1010）。患者按基线射频四分位数分类。主要终点是26周时接受CZP治疗和接受含fc的TNFi治疗的患者的简化疾病活动指数（SDAI）缓解率。次要终点使用基于倾向评分的治疗加权逆概率（PS-IPTW）比较CZP和阿达木单抗（ADA）在每个RF四分位数中的疗效。结果：在整个队列中，SDAI缓解率在第4季度最低（RF≥136.45 IU/mL）。在第4季度，多变量logistic回归分析显示，只有引入CZP与26周时的缓解显著相关。与Q1-Q3相比，含fc的TNFi组在Q4的SDAI缓解率显著降低。相反，两组使用CZP治疗的SDAI缓解率相似。在第4季度调整PS-IPTW后，与ada治疗组（24.5%）相比，czp治疗组的SDAI明显降低，缓解率（36.6%）更高（p = 0.0172）。两组在第一季度至第三季度的SDAI缓解率无显著差异。结论：在RA和高RF水平患者中，CZP可能比含Fc的TNFi更有效。

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Influence of Rheumatoid Factors on the Efficacy of TNF Inhibitor Therapy in Patients with Rheumatoid Arthritis.

Introduction: Although the efficacy of tumor necrosis factor inhibitors (TNFi) is reduced in patients with rheumatoid factor (RF)-high rheumatoid arthritis (RA), certolizumab pegol (CZP), lacking the Fc portion, may not be affected. This study aimed to compare CZP with Fc-containing TNFi and investigate whether RF levels affect the efficacy of CZP in patients with RA.

Methods: This multicenter retrospective study involved patients with RA (n = 1010) who received TNFi with concomitant methotrexate (MTX). Patients were categorized by baseline RF quartiles. The primary endpoint was the Simplified Disease Activity Index (SDAI) remission rates at 26 weeks for patients treated with CZP and those receiving Fc-containing TNFi. The secondary endpoint compared the efficacy of CZP and adalimumab (ADA) in each RF quartile using propensity score-based inverse probability of treatment weighting (PS-IPTW).

Results: In the overall cohort, the SDAI remission rate was the lowest in Q4 (RF ≥ 136.45 IU/mL). In Q4, multivariable logistic regression analysis showed that only the introduction of CZP was significantly associated with remission at 26 weeks. The Fc-containing TNFi group had significantly lower SDAI remission rates in Q4 compared with Q1-Q3. Conversely, the SDAI remission rates were similar between the two groups treated with CZP. After PS-IPTW adjustment in Q4, CZP-treated patients showed a significantly lower SDAI and higher remission rate (36.6%) compared with the ADA-treated patients (24.5%) (p = 0.0172). No significant differences in SDAI remission rates were observed between the two groups in Q1-Q3.

Conclusion: CZP may be more effective than Fc‑containing TNFi in patients with RA and high RF levels.

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来源期刊

Rheumatology and Therapy RHEUMATOLOGY-

CiteScore

6.00

自引率

5.30%

发文量

审稿时长

6 weeks

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