风湿

阿达木单抗治疗白塞病合并静脉血栓疗效优于传统抗风湿药

作者:Emmi G, et al. 翻译:北医三院李常虹 来源:中国风湿病公众论坛 日期:2018-05-21
导读

         阿达木单抗治疗白塞病合并静脉血栓疗效优于传统抗风湿药

关键字:  白塞病 | 阿达木单抗 

        摘要

        目的:由于白塞病是引起炎症诱导的血栓形成的元凶,所以推荐使用免疫抑制剂替代抗凝药。本研究旨在在一个大型回顾性白塞病相关静脉血栓患者中比较阿达木单抗为基础的治疗方案与传统抗风湿药物为基础的治疗方案在临床疗效和助减激素方面的差异。

        方法:我们回顾性收集了70例白塞病合并静脉并发症的患者,这些患者接受了传统抗风湿药或阿达木单抗的治疗方案。为评估血管的反应,我们做了临床和影像学方面的评估。我们比较了阿达木单抗为基础的治疗方案较传统抗风湿药治疗方案在疗效、助减激素以及治疗时长方面的差异。我们同时评估了伴随用药抗凝药的治疗作用。

        结果:经过平均25.7±23.2个月的随访,发现阿达木单抗为基础的治疗方案较传统抗风湿药物治疗方案在诱导静脉血栓后临床和血管结构改善方面更常见,且更快。在最后一次随访中,发生阿达木单抗治疗的患者较传统抗风湿药治疗的患者使用激素的平均剂量更低。治疗的时长在阿达木单抗治疗组更长。在阿达木单抗治疗组或传统抗风湿药治疗组患者,使用抗凝药与否在治疗疗效和时长方面均无差异。

        结论:本大型回顾性研究分析显示,阿达木单抗为基础的治疗方案较传统抗风湿药物治疗方案对于诱导白塞病患者静脉血栓的缓解更有效,更迅速,同时可以减少激素用量。而抗凝药不能够改变两种治疗方式对于白塞病静脉并发症治疗的疗效。

        附全文:

        Abstract

        OBJECTIVES:Since Behçet syndrome (BS) is the prototype of inflammation-induced thrombosis, immunosuppressants are recommended in place of anticoagulants. Here we assessed the clinical efficacy and the corticosteroid-sparing effect of adalimumab (ADA)-based treatment versus DMARDs in a large retrospective cohort of patients with BS-related venous thrombosis.METHODS:We retrospectively collected data from 70 BS patients treated with DMARDs or ADA-based regimens (ADA ± DMARDs) because of venous complications. Clinical and imaging evaluations were performed to define vascular response. We explored differences in outcomes between ADA-based regimens and DMARDs, with respect to efficacy, orticosteroid-sparing role and time on treatment. We also evaluated the role of anticoagulants as concomitant treatment.RESULTS:After a mean follow-up of 25.7±23.2 months, ADA-based regimens induced clinical and instrumental improvement of venous thrombosis more frequently (p=0.001) and rapidly (p<0.0001) than DMARDs. The mean dose of corticosteroids administered at the last follow-up was significantly lower in the ADA-based regimens than in the DMARDs one (p<0.0001). The time on treatment was significantly longer in ADA-based regimens than in the DMARDs one (p=0.002). No differences were found in terms of efficacy and time on treatment between DMARDs or ADA-based regimens among subjects receiving anticoagulants and those who did not.CONCLUSIONS:In this large retrospective study we have shown that ADA-based regimen is more effective and rapid in inducing resolution of venous thrombosis in BS patients than DMARDs, allowing reduction of steroid exposure. Moreover, our findings suggest that anticoagulation does not modify the efficacy on venous complications of either ADA-based regimens or DMARDs.

        引自:Emmi G,Vitale A,Silvestri E,Boddi M,Becatti M,Fiorillo C,Fabiani C,Frediani B,Emmi L,Scala GD,Goldoni M,Bettiol A,Vaglio A,Cantarini L,PriscoD.Adalimumab-based treatment versus DMARDs for venous thrombosis in Behçet syndrome. A retrospective study of 70 patients with vascular involvement.Arthritis Rheumatol.2018 Apr 20.doi:10.1002/art.40531. [Epub ahead of print]

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