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低疾病活动度类风湿关节炎患者可停用TNF抑制剂

2014-12-3 14:03| 发布者: night_jia| 查看: 2106| 评论: 0

摘要: 2014年11月24日美国ACR/ARHP年会报道:低疾病活动度的类风湿关节炎患者有停用肿瘤坏死因子(TNF)抑制剂的可能。 ACR大会中报道了Dr. Jansen 的研究结果,为了探讨低疾病活动度的类风湿关节炎患者是否可以停用TNF抑 ...

2014年11月24日美国ACR/ARHP年会报道:低疾病活动度的类风湿关节炎患者有停用肿瘤坏死因子(TNF)抑制剂的可能。

ACR大会中报道了Dr. Jansen 的研究结果,为了探讨低疾病活动度的类风湿关节炎患者是否可以停用TNF抑制剂,学者进行该研究设计。

共有817名低疾病活动度的类风湿关节炎患者入组该观察,在这些患者中,停用TNF抑制剂后,仍然有53%的患者能在一年内维持稳定的低疾病活动度。并且,TNF抑制剂的使用可以选择直接停用。这种方法已经在外科术前及妊娠妇女的类风湿关节炎患者中使用。


Withdrawal of TNF Inhibitors Possible in Patients With RA, Low Disease Activity

十一月 24, 2014

BOSTON -- November 24, 2014 -- In patients with rheumatoid arthritis (RA) with stable low disease activity, tumour-necrosis factor (TNF) inhibitors can be stopped without the disease flaring.

The findings were presented at the 2014 Annual Scientific Meeting of the American College of Rheumatology/Association of Rheumatology Health Professionals (ACR/ARHP).

Although TNF inhibitors have been shown to be effective in RA, little is known about the effects of their discontinuation in patients with stable low disease activity.

With this in mind, the Potential Optimization of (Expediency) and Effectiveness of TNF-blockers (POET) study was conducted to investigate whether patients in stable low disease activity can stop therapy.

The study included 817 patients with low RA disease activity and a stable dose of disease-modifying anti-rheumatic drugs during the previous 6 months who were randomised 2:1 to either stop (65%) or continue (35%) their TNF inhibitor therapy.

According to Tim Jansen, MD, Radboud University Medical Center, Nijmegen, the Netherlands, after the study began, “there was a switch of mind-set” with many patients who had initially chosen not to enrol, later deciding that they did want to know whether they could do without TNF inhibitors.

The data showed that 46.9% of patients who stopped their TNF inhibitor experienced a disease flare (Disease Activity Score in 28 joints [DAS28] ≥3.2 with an increase ≥0.6), compared with 9.4% of those who continued their therapy (P < .001).

In patients who stopped taking their TNF inhibitor, the median time to first flare in was 24 weeks, with a median time of 14 weeks to regain low disease activity.

According to the researchers, flare-free discontinuation of TNF inhibitor was possible in 53% of patients with stable low RA disease activity during the 12-month study period.

Dr. Jansen noted that when the study was being designed, the researchers discussed whether to perform a taper study or a stop study. He emphasised that nobody wanted the option of a taper and dose reduction study, instead favouring abrupt discontinuation of therapy. He said that abrupt discontinuation is safer, and this method has already been used in patients prior to surgery, as well as in pregnant women.

“Now we also know that if you flare, you’ll get it soon, and if needed, you can restart,” he added.

SOURCE: American College of Rheumatology



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