有效的二线b/tsDMARDs对于类风湿性关节炎患者没有响应第一线b/tsDMARDs从FIRST注册表
Ryuichiro Kanda1, Yusuke Miyazaki1, Shingo Nakayamada1
1First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahata-nishi-ku, Kitakyushu, Fukuoka, 807-8555, Japan.
Rheumatology and therapy
|March 2, 2025
概括
对于对初始治疗没有反应的类风湿性关节炎 (RA) 患者来说,Janus激酶抑制剂 (JAKi),特别是上巴西替尼 (UPA),显示出作为有效的二线疗法的希望. 这些JAK抑制剂在24周内改善了疾病活性和缓解率.
科学领域:
- 类风湿病学 类风湿病学
- 免疫学 免疫学 免疫学
- 药理学 药理学是指药理学的学科.
背景情况:
- 类风湿性关节炎 (RA) 管理需要有效的二线疗法,用于那些对最初的生物/向性合成疾病修饰性抗风湿药物 (b/tsDMARDs) 无反应的患者.
- 缺乏选择二线b/tsDMARDs的明确指标可能导致疾病进展和难以治疗的RA (D2TRA).
- 这项研究评估了基于欧洲反风湿联盟 (EULAR) 建议的二线b/tsDMARD策略.
研究的目的:
- 确定最佳的二线b/tsDMARDs,用于RA患者,对一线治疗反应不足.
- 为了比较不同类别的二线b/tsDMARDs的疗效和安全性,包括瘤坏死因子抑制剂,白蛋白-6受体抑制剂,细胞毒性T淋巴细胞相关蛋白4免疫球蛋白和Janus激酶抑制剂 (JAKi).
主要方法:
- 从2013年10月到2023年4月,对687名RA患者进行了回顾性分析,这些患者接受了二线b/tsDMARD治疗.
- 临床疾病活动指数 (CDAI) 缓解,低疾病活动 (LDA) 率,CDAI变化,持续性和24周内不良事件的比较.
- 基于倾向分数的治疗权重的反向概率 (PS-IPTW) 用于减轻选择偏差.
主要成果:
- 在PS-IPTW调整后,Janus激酶抑制剂 (JAKi) 显示了最高的持久率.
- 在24周后,JAKi组在CDAI中表现出最大的改善和最高的CDAI缓解率.
- 与其他JAKis (托法西提尼布,巴里西提尼布) 相比,Upadacitinib (UPA) 是一种JAKi,在24周后与较高的CDAI缓解率和较低的疾病活性评分有关,具有可比的持久性,并且在不良事件中没有显著差异.
结论:
- 雅努斯激酶抑制剂 (JAKi),特别是乌帕达西丁 (UPA),代表了对第一线b/tsDMARDs无反应的RA患者的有希望的二线治疗选择.
- 在这种患者群体中,UPA可能会显著改善疾病活性,并比其他JAKis更有效地实现缓解.
- 需要进一步的大规模研究来证实UPA在RA治疗中的疗效和安全性.
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