风湿

类风湿并间质性肺病患者用利妥昔单抗治疗死亡率低于肿瘤坏死因子抑制剂

作者:Druce KL , et al. 翻译:北医三院李常虹 来源:中国风湿病公众论坛 日期:2018-06-18
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         类风湿并间质性肺病患者用利妥昔单抗治疗死亡率低于肿瘤坏死因子抑制剂

关键字:  类风湿关节炎 

        摘要:目的:自有报道提示类风湿关节炎合并间质性肺病(RA-ILD)患者使用肿瘤坏死因子抑制剂(TNFi)后会出现ILD的新病变或原来病情的加重后,RA的治疗指南已经指出在使用此类药物时应特别小心。目前我们对于RA-ILD接受利妥昔单抗治疗后的结局知之甚少。本研究比较了首选TNFi和首选利妥昔单抗治疗RA-ILD死亡率方面的差异。

        方法:接受生物制剂治疗的RA-ILD患者被纳入本项研究。采用Cox回归方法计算死亡率和比较风险差异。记录死亡的原因,包括ILD在死亡证明上出现的频率。

        结果:43例使用利妥昔单抗和309例使用TNFi的患者被纳入本项研究。接受利妥昔单抗治疗的患者病程更短和肢体残疾程度更轻。每1000人年的死亡率分别是94.8%和53%。经过调整后的死亡风险在利妥昔单抗治疗组减半,但两组间仍无统计学差异。7例接受利妥昔单抗治疗死亡的患者中有1例死于ILD,而76例接受TNFi治疗死亡的患者中有12例死于ILD。

        结论:RA-ILD患者接受利妥昔单抗治疗的死亡率低于接受TNFi治疗组。但因缺乏ILD严重程度或亚型方面的相关信息,所以目前尚无法得出哪一种药物是RA-ILD和活动性关节炎的最优选择。

        附原文:AbstractOBJECTIVES: Guidelines cautioned prescribing of tumour necrosis factor inhibitors (TNFi) to patients with rheumatoid arthritis and interstitial lung disease (RA-ILD) after reports of new or worsening of ILD. Less is known about outcomes among patients with RA-ILDwho receive rituximab (RTX). This study compares mortality in patients with RA-ILD who received RTX or TNFi as their first biologic.METHODS: Participants with RA-ILD recruited to the British Society for Rheumatology Biologics Register for RA were included. Death rates were calculated and risk comparisons were made using Cox regression. Causes of death, including the frequency in which ILD was recorded on death certificates were examined.RESULTS: 43 patients on RTX and 309 on TNFi were included. RTX recipients had shorter disease duration and less disability. Death rates were 94.8 (95%CI: 74.4 to 118.7) and 53.0 (22.9 to 104.6) per 1000 person years, respectively. The adjusted mortality risk was halved in the RTX cohort, but the difference was not statistically significant (HR 0.53, 95% CI: 0.26 to 1.10). ILD was the underlying cause of death in 1 of 7 RTX deaths (14%) and 12 of 76 TNFi deaths(16%).CONCLUSIONS: Patients with RA-ILD who received RTX had lower mortality rates compared to TNFi. The absence of information on ILD severity or subtype prevents conclusions of which drug represents the best choice in patients with RA-ILD and active arthritis.

        引自:Druce KL, Iqbal K, Watson KD, Symmons DPM, Hyrich KL, Kelly C.Mortality in patients with interstitial lung disease treated with rituximab or TNFi as a first biologic. RMD Open. 2017 Jul 13;3(1):e000473. doi: 10.1136/rmdopen-2017-000473. eCollection 2017

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