用生物或向合成DMARD治疗的类风湿性关节炎患者的COVID-19结局
Jih-Jin Tsai1,2,3, Li-Teh Liu4, Chun-Hong Chen5,6
1Tropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
RMD open
|July 21, 2023
概括
使用Janus关联激酶抑制剂 (JAKi) 的类风湿性关节炎 (RA) 患者与使用瘤坏死因子α抑制剂 (TNFi) 患者相比,面临住院和COVID-19死亡的风险更高. 疫苗接种对于这个群体至关重要.
科学领域:
- 类风湿病学 类风湿病学
- 传染性疾病 传染性疾病
- 药物监督 药物监督 药物监督
背景情况:
- 类风湿性关节炎 (RA) 患者经常使用生物或向性合成疾病修饰性抗风湿药物 (b/tsDMARDs).
- 了解不同b/tsDMARDs对COVID-19结果的影响对于患者管理至关重要.
研究的目的:
- 调查针对RA和COVID-19结果的特定b/tsDMARD暴露之间的关联.
- 为了比较不同b/tsDMARDs的用户中COVID-19感染和不良事件的风险.
主要方法:
- 在TriNetX (2018-2022) 中使用美国协作网络的回顾性队列研究.
- 倾向性评分匹配 (PSM) 对比了Janus相关激酶抑制剂 (JAKi) 和干白素6抑制剂 (IL-6i) 与瘤缩因子α抑制剂 (TNFi) 的使用者.
- 结果包括COVID-19发病率,住院,重症监护,机械通风和死亡率.
主要成果:
- 与TNFi使用者相比,接受JAKi治疗的RA患者的住院风险显著增加 (HR: 1.194),死亡率 (HR: 1.440),以及复合不良结果.
- 在JAKi和TNFi用户之间没有观察到COVID-19发病率的显著差异.
- 在未接种疫苗的JAKi用户中,死亡风险明显高 (HR: 1.511). 与TNFi用户相比,IL-6i用户没有显示这些增加的风险.
结论:
- 在RA中使用Janus相关激酶抑制剂 (JAKi) 与严重COVID-19结果的风险增加有关,特别是死亡率,特别是在未接种疫苗的个体中.
- 强烈建议RA患者在JAKi上接种COVID-19疫苗.
- 临床医生应保持警RA患者治疗JAKi的早期干预不良事件.
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