银屑病关节炎的常规合成制剂:生物制剂时代的变革实践来自HURBIO-PsA注册表的真实结果

IF 0.3 4区 医学 Q4 Medicine
E. Bilgin, U. Kalyoncu
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引用次数: 0

摘要

目的:银屑病关节炎是一种慢性肌肉骨骼疾病,可影响皮肤,关节,骨骼和髋部。常规合成抗病性抗风湿药物是一线治疗选择,对于常规合成抗病性抗风湿药物不耐受/控制不好的银屑病关节炎患者,推荐使用生物抗病性抗风湿药物。虽然目前已有常规合成疾病修饰抗风湿药物的生存数据,但生物疾病修饰抗风湿药物对常规合成疾病修饰抗风湿药物保留的影响仍然是一个值得关注的问题。材料和方法:银屑病关节炎患者在开始使用生物疾病修饰抗风湿药物时接受至少1剂生物疾病修饰抗风湿药物,使用至少1种传统合成疾病修饰抗风湿药物(甲氨蝶呤、来氟米特、羟氯喹和磺胺嘧啶),并在Hacettepe大学生物数据库-银屑病关节炎中登记,纳入本回顾性纵向分析。收集首次和最后一次随访时的人口统计学和疾病特异性数据。评估各种常规合成疾病修饰抗风湿药物的未调整保留率。比较常规综合抗风湿药首访和末访时的总体处方。结果:共纳入266例患者,其中女性191例,占71.8%。生物治疗组的中位随访时间为43.4(19.4-80.1)个月。两种常规合成抗风湿药物的中位保留时间相似。在第一次和最后一次访问之间;甲氨蝶呤使用率下降29.3% (61.7% vs 43.6%;P <0.001),来氟米特使用率下降8.4% (31.2% vs 28.6%;P =0.30),磺胺吡啶的使用减少30.0% (11.3% vs. 7.9%;P =0.05),羟氯喹使用减少31.1% (16.9% vs. 11.7%;P =0.001),糖皮质激素使用减少12.5% (51.1% vs. 44.7%;p = 0.015)。末次访时,59例(22.2%)患者不使用常规综合抗风湿药物,20例(7.5%)患者仅使用糖皮质激素,39例(14.7%)患者使用常规综合抗风湿药物+不使用糖皮质激素。结论:虽然有相当一部分患者在开始使用生物疾病修饰类抗风湿药物后明显停用了常规合成疾病修饰类抗风湿药物,但最后一次就诊时使用糖皮质激素的患者比例仍然很高。需要进行旨在证明何时、对谁以及如何停用常规合成疾病修饰抗风湿药的研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Conventional Synthetic Dmards in Psoriatic Arthritis: Changing Practice in Biologic Era; Real-Life Results from HURBIO-PsA Registry
Objectives: Psoriatic arthritis is a chronic musculoskeletal disorder which may affect skin, joints, bone and enthesis. Conventional synthetic disease modifying anti-rheumatic drugs are first-line treatment options and biologic disease modifying anti-rheumatic drugs are recommended in psoriatic arthritis patients who are intolerant/not controlled well with conventional synthetic disease modifying anti-rheumatic drugs. Although survival data of the conventional synthetic disease modifying anti-rheumatic drugs without concomitant biologic disease modifying anti-rheumatic drugs are available, the effect of biologic disease modifying anti-rheumatic drugs on the retention of conventional synthetic disease modifying anti-rheumatic drugs is still a question of interest. Materials and Methods: Psoriatic arthritis patients who received at least 1 dose of biologic disease modifying anti-rheumatic drugs, using at least 1 conventional synthetic disease modifying anti-rheumatic drugs (methotrexate, leflunomide, hydroxychloroquine and sulfasalazine) at the time of biologic disease modifying anti-rheumatic drugs starting visit and registered in the Hacettepe University BIOlogical Database-Psoriatic Arthritis were included in this retrospective longitudinal analysis. Demographic and disease-specific data at first and last follow-up visit were collected. Unadjusted retention rate of each conventional synthetic disease modifying anti-rheumatic drugs was assessed. Overall prescription of conventional synthetic disease modifying anti-rheumatic drugs at first and last follow-up visit were compared. Results: A total of 266 (191(71.8%) female) patients was included. Median follow-up duration under biologic treatment was 43.4 (19.4-80.1) months. Median retention duration of each conventional synthetic disease modifying anti-rheumatic drugs were similar. Between the first and last visit; there was a 29.3% decrease in methotrexate use (61.7% vs. 43.6%; p<0.001), 8.4% decrease in leflunomide use (31.2% vs. 28.6%; p=0.30), 30.0% decrease in sulfasalazine use (11.3% vs. 7.9%; p=0.05), 31.1% decrease in hydroxychloroquine use (16.9% vs. 11.7%; p=0.001), 12.5 % decrease in glucocorticoids use (51.1% vs. 44.7%; p=0.015). At last visit, 59 (22.2%) patients were conventional synthetic disease modifying anti-rheumatic drugs -free: 20 (7.5%) patients were using only glucocorticoids, 39 (14.7%) patients were conventional synthetic disease modifying anti-rheumatic drugs + glucocorticoid-free. Conclusion: Although conventional synthetic disease modifying anti-rheumatic drugs were significantly discontinued in an important percent of patients after the initiation of biologic disease modifying anti-rheumatic drugs, percentage of patients using glucocorticoids at last visit was still high. Studies aiming to demonstrate when, in whom and how to discontinue conventional synthetic disease modifying anti-rheumatic drugs are needed.
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来源期刊
Acta Medica Mediterranea
Acta Medica Mediterranea 医学-医学:内科
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0
审稿时长
6-12 weeks
期刊介绍: Acta Medica Mediterranea is an indipendent, international, English-language, peer-reviewed journal, online and open-access, designed for internists and phisicians. The journal publishes a variety of manuscript types, including review articles, original research, case reports and letters to the editor.
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