台湾学者报道RA达标治疗经验：持续6个月良好反应者方可减停依那西普

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AB0437 DOSE TITRATION OF ETANERCEPT USING DISEASE ACTIVITY SCORE (DAS28) IN TREATMENT OF PATIENTS WITH RHEUMATOID ARTHRITIS IN TAIWAN   N.-S. Lai 1, 2,*   1Allergy, Immunology and Rheumatology, DALIN TZUCHI GENERAL HOSPITAL, CHIAYI, TAIWAN, ChiaYi, 2Medicine, School of Medicine, Tzu Chi University, Hwa Lan, Taiwan, Province of China   Background: To evaluated treatment outcome of Enbrel in RA patients with dose escalation according to EULAR response criteria Objectives: We prospectively evaluated the effects and the results of dose escalation of entanercep in Chinese patients with rheumatoid arthritis(RA) Methods: We prospectively evaluated the effects of dose escalation of biological agent in 90 Chinese patients with RA since Jan 2007, treated entanercept(Enbrel) 25mg twice weekly according to guide line for anti-TNF-biological agents for RA. Patients were evaluated at 24th, 36th, and 48th weeks and every 3 months thereafter. Doses were titrated according to with Disease Activity Score (DAS28) and EULAR improvement criteria (continued conventional 25mgBIW, dose tapering to 25mg QW and dose discontinuation) according to flow chart. Results: Total ninety RA patients were included in this brief observation.  Nine patients (10%) were withdrawn from etanercept treatment in the first 6 months due to no response (7 patients) and side effects (2 patients).  Eighty one patient (90%) achieved good or moderate responses (EULAR improvement criteria ) in the first 6 months treatment course with etanercept 25mg BIW.  Fifty-four of these 81 patients had an opportunity for dose tapering to 25mg QW for disease maintenance once fulfill the criteria of achievement of good response with 25mg BIW for consecutive 6 months.  It was noted that 14 patients of them could maintained well continuously with 25 mg QW, 24 patients finally discontinued the etanercept treatment (DAS<1.6 for consecutive 6 months).  Sixteen patients relapsed, however, and must return to conventional 25mg BIW suggested dose.  In conclusion, 9 patients were treatment failure (10%).  After switch to small dose, 24 patients were in remission state (26.7%), 21 patients were in good response (23.3%).  Thirty-six patients (40%) were treated with BIW dose (27 patients since the beginning and another 9 patients were from tapering failure). Conclusions: The preliminary data showed that dose escalation of Enbrel in treatment of RA patients was valuable in clinical management of patients.  The bony erosion in these patients was evaluated in this study.

台湾学者报道RA达标治疗经验：持续6个月良好反应者方可减停依那西普   Lai NS. EULAR 2011. Present No: AB0437     背景: 评价Enbrel治疗RA患者时依据EULAR反应标准调整剂量的疗效 目的: 前瞻性对依那西普治疗中国RA患者时剂量调整的效果和影响进行评估 方法: 我们前瞻性评价了2007年1月以来,生物制剂治疗90例中国RA患者剂量调整的影响,患者均根据抗-TNF拮抗剂使用指南接受依那西普( Enbrel)25mg每周两次治疗。在第24、36、48周对患者进行评估，以后每3个月一次。根据流程图参照疾病活动指数（DAS28）和EULAR改善标准调整药物剂量（继续传统的25mgBIW，剂量减少至25mg QW和停用)。 结果: 共90例 RA患者纳入这一简单的观察。有9例(10%)依那西普治疗患者在最初6个月内因无效（7例）和副反应(2例)退出。81例患者(90%)在最初6个月内接受依那西普25mg BIW获得良好或中度的反应(EULAR改善标准)。54/81例患者依那西普25mgBIW连续6个月符合效果良好标准后即有机会减量至25mg QW维持。其中，14例患者能应用依那西普25mg QW持续维持良好，有24例患者最终停用依那西普（DAS< 1.6连续6个月)。然而,有16名患者疾病复发，并必须回到传统的25mg BIW建议剂量。总结一下,9例患者治疗失败(10%)。转换至小剂量后,24例(26.7%)持续缓解,21例患者反应良好(23.3%)。36例(40%)患者仍然应用BIW的剂量（27例从开始持续应用，而另外9例则是减量失败)。 结论: 初步数据显示,Enbrel剂量调整在RA患者治疗的临床管理中是有价值的。本研究还检测该患者人群中骨侵蚀的变化。