美国退伍军人患有类风湿性关节炎相关的间歇性肺病的先进疗法:回顾性,主动比较,新用户,队列研究
Bryant R England1, Joshua F Baker2, Michael D George3
1US Department of Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, Omaha, NE, USA; University of Nebraska Medical Center, Omaha, NE, USA.
The Lancet. Rheumatology
|January 10, 2025
概括
对于类风湿性关节炎相关的间歇性肺病 (RA-ILD),TNF抑制剂与其他向疗法相比,显示出类似的生存和呼吸结果. 这些发现表明,在RA-ILD患者中,TNF抑制剂可以在没有系统避免的情况下使用.
科学领域:
- 类风湿病学 类风湿病学
- 肺部病理学 肺部病理学
- 药理学 药理学是指药理学的学科.
背景情况:
- 在RA-ILD中,TNF抑制剂与其他DMARD相比,患者的治疗结果存在不确定性.
- 这项研究比较了RA-ILD患者的生存率和呼吸系统住院情况,这些患者开始使用TNF抑制剂或非TNF抑制剂.
研究的目的:
- 以TNF抑制剂治疗的风湿性关节炎相关间歇性肺病 (RA-ILD) 患者的生存和呼吸系统住院结果进行比较,与非TNF抑制剂生物或向合成DMARDs相比.
主要方法:
- 使用美国退伍军人事务部 (VA) 数据进行了回顾性,主动比较,新用户观察队列研究.
- 倾向性得分匹配用于474名RA-ILD患者 (237名TNF抑制剂启动者,237名非TNF抑制剂启动者).
- 评估的结果包括呼吸系统住院,全因死亡率和3年的呼吸系统相关死亡.
主要成果:
- 在TNF抑制剂和非TNF抑制剂组之间没有观察到死亡或呼吸系统住院的显著差异.
- 具体的结果,如呼吸道住院 (aHR 1.27),全因死亡率 (aHR 1.15) 和呼吸道死亡率 (aHR 1.38) 没有显著差异.
- 二次性,敏感性和子组分析支持了这些主要发现.
结论:
- 在患有RA-ILD的美国退伍军人中,TNF抑制剂表现出与非TNF生物或向合成DMARDs可比的结果.
- 这些发现并不支持在所有RA-ILD患者中系统地避免使用TNF抑制剂.
- 由于观察性研究中的潜在残留混,建议进行比较疗效试验.
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