在慢性炎症性关节炎患者的单一治疗和组合治疗中,初始向治疗策略的现实世界持久性
Lorena Exposito1, Carlos Sánchez-Piedra2, Paloma Vela-Casasempere3
1Rheumatology Unit, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
European journal of clinical investigation
|September 16, 2023
概括
将生物/向合成DMARD与常规合成DMARD相结合,在类风湿性关节炎,牛皮性关节炎和性脊柱炎患者中显示持续性较低,不良事件较多. 这表明重新考虑组合疗法作为首选治疗方法,特别是在PsA和AS.
科学领域:
- 类风湿病学 类风湿病学
- 药理学 药理学是指药理学的学科.
- 临床研究 临床研究
背景情况:
- 生物/向性合成修饰性抗风湿药物 (b/tsDMARDs) 在单一治疗与常规合成DMARDs (csDMARDs) 组合中的比较有效性和安全性在风湿性疾病中仍在争论中.
- 在指导临床实践方面,关于治疗保留和安全性概况的真实数据至关重要.
研究的目的:
- 评估在类风湿性关节炎 (RA),牛皮性关节炎 (PsA) 和性脊柱炎 (AS) 患者中使用b/tsDMARDs单独治疗与csDMARDs联合治疗的初始治疗策略的保留.
- 确定与维持这些初始治疗策略相关的因素.
主要方法:
- 使用西班牙BIOBADASER III注册表的数据进行了一个嵌套队列研究.
- 使用双变量比较和多变量考克斯比例危险模型来分析治疗持久性和相关因素.
主要成果:
- 这项研究包括2521名患者. 组合疗法与RA (HR 1.58),PsA (HR 2.48) 和AS (HR 16.77) 患者的持续时间明显较短有关.
- 性别,疾病持续时间,基线活性和葡萄糖皮质激素使用等因素并没有改变这种关联.
- 组合疗法也显示了较高的不良事件发生率 (IRR 1.13).
结论:
- 在现实世界中,将b/tsDMARDs与csDMARDs结合使用与单独治疗RA,PsA和AS相比,与较低的持久性和较差的安全性相关.
- 这些发现表明,应重新考虑组合疗法作为一线治疗方法,特别是对于PsA和AS患者.
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