哪些类风湿患者适于用托珠单抗治疗?

作者:发布时间:2013/12/10 9:52:38

摘要(法国)目的:本研究的目的是在临床实践中探讨类风湿关节炎(RA)患者对托珠单抗(TCZ)反应和缓解的预测因素。

方法:根据EULAR反应标准评估TCZ治疗12周和24周后的疗效。应用回归分析的方法研究RA患者的缓解或达到EULAR反应标准与以下特点之间的相关性。具体的特点包括性别、年龄、目前吸烟、先前有心血管疾病、DAS28、CRP、RF或ACPA阳性、DMARDs的联合治疗以及TCZ作为第一种生物制剂治疗或作为至少一种生物制剂失败后用药。

结论:本研究总共纳入204例患者,平均DAS28水平为5.14分。TCZ治疗24周时EULAR的反应和缓解率分别为86.1%和40%。多元回归分析显示,基线时高CRP水平与24周时EULAR反应情况成正相关[比值比4.454 (95% CI 1.446, 13.726)],相反,年龄大于55岁[OR 0.285 (95% CI 0.086, 0.950)]以及先前有心血管疾患[OR 0.305 (95% CI 0.113, 0.825)]与24周时EULAR反应情况成负相关。老龄也与24周时缓解情况较差存在相关性[OR 0.948 (95% CI 0.920, 0.978)]。对于TCZ联合一种DMARD药物治疗的患者或者初次接受生物制剂治疗的患者没再有阳性发现。

结论:在日常的临床实践中我们发现了三个TCZ治疗RA反应良好的预测因素:年轻、基线时CRP水平高及没有心血管疾患的病史。

附全文:Abstract Objective. The objective of this study was to identify predictors of response and remission to tocilizumab (TCZ) in RA patients seen in daily routine clinical practice. Methods. The efficacy of TCZ was evaluated after 12 and 24 weeks of treatment by the European League Against Rheumatism (EULAR) response criteria. Regression analysis was performed to study the association between remission or EULAR response and the following characteristics: gender, age, current smokers, prior cardiovascular disease (CVD), 28-joint disease activity score (DAS28), CRP, RF or ACPA positivity, combination therapy with DMARDs and TCZ as the first biological therapy or after failure of at least one biological therapy. Results. In total, 204 patients were included with a mean DAS28 score of 5.14. EULAR response and remission were obtained in 86.1% and 40% of patients, respectively, at week 24. In multiple regression analysis, a high baseline CRP level [odds ratio (OR) 4.454 (95% CI 1.446, 13.726)] was significantly associated with EULAR response at week 24 and, inversely, age >55 years [OR 0.285 (95% CI 0.086, 0.950)] and prior CVD [OR 0.305 (95% CI 0.113, 0.825)] were significantly associated with lower EULAR response at week 24. Older age was also associated with less remission at week 24 [OR 0.948 (95% CI 0.920, 0.978)]. No additional effectiveness was found when TCZ was used in combination with a DMARD or when patients were naive to biological agents. Conclusion. In daily practice we identified three predictors of a better response for TCZ therapy in RA: a younger age, a high baseline CRP level and no history of CVD.

引自:Pers YM, Fortunet C, Constant E, Lambert J, Godfrin-Valnet M, De Jong A, Mercier G, Pallot Prades B, Wendling D, Gaudin P, Jorgensen C, Marotte H, Maillefert JF. Predictors of response and remission in a large cohort of rheumatoid arthritis patients treated with tocilizumab in clinical practice. Rheumatology (Oxford). 2013 Sep 19. [Epub ahead of print]