[需要bDMARDs/JAKi切换的类风湿性关节炎患者的无效治疗的预测因素:来自单中心前性研究的数据]
A O Bobkova1, A M Lila1,2, A E Karateev1
1Nasonova Research Institute of Rheumatology.
Terapevticheskii arkhiv
|February 18, 2026
概括
在类风湿性关节炎 (RA) 中切换生物修饰性抗风湿药物 (bDMARDs) 或Janus激酶抑制剂 (JAKi) 通常是无效的. 较高的BMI,疼痛和心理因素预测对这些RA治疗的反应不佳.
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) 治疗目标往往无法实现,即使使用了bDMARD和JAKi等先进疗法.
- 治疗失败需要切换到替代bDMARDs或JAKi,但成功的预测因素是未知的.
研究的目的:
- 为了确定与RA患者因之前的无效性而转换bDMARDs/JAKi的治疗反应不佳相关的因素.
- 在RA中开发bDMARDs/JAKi转换后治疗结果的预测模型.
主要方法:
- 分析了164名先前bDMARD/JAKi失败的RA患者.
- 疾病活动评分 (DAS28-CRP) 在转换6个月后进行评估.
- 用二进制后勤回归来识别反应差的预测因素.
主要成果:
- 48.8%的患者表现出不良反应 (DAS28-CRP> 3.2).
- 预测不良反应的预测因素包括更高的BMI,RA发病年龄,更大的关节数量,更严重的疼痛和心理痛苦.
- 结合BMI,RF血清阴性,中央敏感化库存 (CSI),神经病痛和葡萄糖皮质体 (GC) 使用的预测模型实现了77.5%的灵敏度和70.2%的特异性.
结论:
- 较高的基线RA活性,疼痛严重程度,BMI,中央敏感性和精神情绪障碍预测在切换bDMARDs/JAKi时的结果不好.
- 在基线使用葡萄糖皮质激素也与治疗切换的负面反应有关.
- 这些发现有助于个性化RA治疗策略.
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