背景

        本研究旨在描述强直性脊柱炎患者在接受首次TNFi治疗之后5年期的治疗轨迹。

        方法

        2006-2015年间，瑞典风湿质量登记处未接触过生物疗法的强直性脊柱炎患者开始接受TNFi疗法。研究人员在随访期间对受访者抗风湿疗法的变化进行记录。为了提高研究精确度，研究人员同时还从瑞典处方药登记处收集了各大药房每年皮下TNFi注射剂量。

        结果

        在2006至2015年期间，共有2590名强直性脊柱炎患者开始接受TNFi治疗，一年后，有74%患者继续用TNFi进行治疗。但在5年后，这一数据仅为46%。受访者中63%的患者仍使用生物制剂，剩下30%不接受抗风湿治疗。停用首个TNFi后，46%的患者直接更换TNFi, 较之首个TNFi,之后续用的第二和第三种TNFi药物滞留时间依次缩短。反之， 沿用首个皮下TNFi的患者 逐渐减少剂量。治疗开始后的第五年，只有66%的受试者TNFi剂量 ≥ 每日指定剂量的75%。

        结论

        5年后，不到一半强直性脊柱炎患者仍延续首个TNFi治疗，其他患者大多也使用生物制剂治疗。治疗开始5年后，延续首个TNFi治疗的患者逐渐减少了剂量，其他患者更换生物制剂，1/3患者未接受任何抗风湿治疗。研究结果充分说明了随访项目和替代疗法的重要性。

        原 文

        Biological treatment ofankylosing spondylitis: a nationwide study of treatment trajectories on a patient level in clinical practice.

        Objective

        The aim of this study was to describe 5-year treatment trajectories in patients with ankylosing spondylitis (AS) starting a first TNFi.

        Methods

        Bio-naïve patients with AS starting a TNFi in 2006-2015 were identified in the nationwide Swedish Rheumatology Quality register and followed until 31 December 2015. All changes in their anti-rheumatic treatment during follow-up were recorded. To further increase precision, these data were complimented by information on the amount of prescribed subcutaneous TNFi collected from pharmacies during each year, retrieved from the Swedish Prescribed Drug Register.

        Results

        Two thousand five hundred ninety patients started a first TNFi 2006-2015, and after 1 year, 74% remained on their first TNFi. However, after 5 years, this figure was only 46%, although at that time 63% were still on treatment with any biologic, while 30% had no anti-rheumatic treatment at all. After discontinuing the first TNFi, 46% switched directly to a second TNFi, but the drug retention for the second and third TNFi grew successively shorter compared to that for the first TNFi. In contrast, patients remaining on treatment with their first subcutaneous TNFi gradually reduced the dose, so that during the fifth year of treatment only 66% had collected ≥ 75% of the defined daily doses for that year.

        Conclusions

        Less than half of patients with AS will remain on their first TNFi after 5 years, but most are still on a biologic. While patients remaining on treatment with their first TNFi appear to be able to reduce the dose over time, a large proportion cycle through several biologics, and 1/3 have no anti-rheumatic treatment after 5 years. This indicates the importance of thorough follow-up programs as well as a need for alternative therapeutic options.

        文章出处:

        https://www.ncbi.nlm.nih.gov/pubmed/31138285

        Lindström U, et al.

        Arthritis Res Ther.

        2019.05.28