764例银屑病关节炎患者使用TNF抑制剂的疗效、药物持续使用情况及其相关预测因素：来自丹麦DANBIO登记中

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Arthritis Rheum. 2010 Oct 27. [Epub ahead of print] Treatment response, drug survival and predictors thereof in 764 patients with psoriatic arthritis treated with anti-tumor necrosis factor α therapy: Results from the Danish nationwide DANBIO registry. Glintborg B, Ostergaard M, Dreyer L, Krogh NS, Tarp U, Hansen MS, Rifbjerg-Madsen S, Lorenzen T, Hetland ML. Department of Rheumatology, Gentofte University Hospital, Denmark. Abstract OBJECTIVES: Based on prospectively registered data from the Danish nationwide DANBIO database to investigate disease activity, treatment responses, drug survival and predictors thereof among patients with psoriatic arthritis (PsA) receiving their first treatment series with a tumor-necrosis-factor-alpha(TNFα)-inhibitor. METHODS: Among PsA patients identified in DANBIO, clinical response (achievement of ACR20, ACR50, ACR70 or EULAR-good-response at least once during the first 6 months' treatment), drug survival and predictors thereof were studied. Data registration was from year 2000-2009. RESULTS: In total, 764 patients (52% women, disease duration 5(2-11) years (median(interquartile range), age 47(38-56) years) were identified. 320(42%) received adalimumab, 260(34%) infliximab, and 184(24%) etanercept. Parameters at baseline/6 months follow-up were: CRP 10(4-22)/4(1-9) mg/l, Health Assessment Questionnaire (HAQ) 1.0(0.6-1.5)/0.6(0.1-1.1), 28-joint Disease Activity Score (DAS28) 4.8(3.9-5.5)/2.8(1.9-3.9). Median drug survival was 2.9 years, 1- and 2-year survival rates were 70% and 57%, respectively. Baseline characteristics associated with longer drug survival were male gender, CRP>10mg/l, methotrexate use and low patient global score. ACR20, ACR50, ACR70 and EULAR-good-response were achieved by 59%, 45%, 24% and 54% of patients, respectively. CRP>10mg/l was predictive of ACR20 (odds ratio, 95% confidence interval) (2.6, 1.7-3.9), ACR50 (3.0, 2.0-4.5), ACR70 (3.6, 2.2-5.9) and EULAR-good-response (2.2, 1.5-3.2). CONCLUSION: In 764 PsA patients treated with their first TNFα-inhibitor in clinical practice, the median drug survival was 2.9 years. The ACR50 response rate was 45%. Increased CRP at baseline was associated with both good treatment responses and continued treatment, which may be of clinical value in selecting the patients most likely to benefit from treatment with TNFα-inhibitor.

764例银屑病关节炎患者使用TNF抑制剂的疗效、药物持续使用情况及其相关预测因素：来自丹麦DANBIO登记中心的结果 Glintborg B,et al.Arthritis Rheum. 2010 Oct 27.   目的：分析丹麦DANBIO数据库的前瞻性登记数据，探讨使用TNFα的银屑病关节炎（PsA）患者的疾病活动度、疗效、药物持续使用情况及其相关预测因素。   方法：研究2000-2009年DANBIO中PsA患者的临床疗效（在治疗的最初6个月内达到ACR20、ACR50、ACR70或至少1次达到EULAR反应良好）、药物持续使用情况及其相关预测因素。 结果：共纳入764例患者，52%女性，平均病程5年（2-11年），平均年龄47岁（38-56岁）。320例（42%）使用阿达木单抗，260例（34%）使用英夫利昔单抗，184例（24%）使用依那西普。基线期/随访6个月的数据如下：CRP 10(4-22)/4(1-9) mg/L，HAQ 1.0(0.6-1.5)/0.6(0.1-1.1)，DAS28 4.8(3.9-5.5)/2.8(1.9-3.9)。平均药物持续使用时间为2.9年，1年、2年持续使用率分别为70%、57%。与药物持续使用时间更长相关的基线期特征为男性、CRP>10mg/L、使用甲氨蝶呤和患者总体评分低。ACR20、ACR50、ACR70和EULAR反应良好的达到率分别为59%、45%、24%和54%。CRP>10mg/L是ACR20 (比值比，95%可信区间) (2.6, 1.7-3.9)、ACR50 (3.0, 2.0-4.5)、ACR70 (3.6, 2.2-5.9)和EULAR反应良好 (2.2, 1.5-3.2)的预测因素。 结论：在使用第一种TNFα抑制剂的764例PsA患者中，平均药物持续使用时间为2.9年。ACR50反应率为45%。基线期CRP升高与疗效好、持续治疗相关，这可能有助于临床上选择最适合使用TNFα抑制剂的患者。