Marco Sebastiani, Alen Zabotti, Bruno Biasi, Sofia Cacioppo, Gilda Sandri, Ivan Giovannini, Andreina Manfredi, Luca Quartuccio
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引用次数: 0
Abstract
Objectives: We aimed to retrospectively evaluate retention rate and causes of discontinuation of JAKi in rheumatoid arthritis (RA) patients with particular regards to difficult-to-treat subgroups.
Methods: The diffusion of Janus kinase inhibitors (JAKi) for the treatment of RA has rapidly increased in recent years due to their effectiveness, even in difficult-to-treat subgroups of patients. After the publication of the Oral Surveillance study, the labelling of JAKi was modified, advising against their use in elderly patients and those at risk for cardiovascular events and malignancies. Demographic, clinical, serological and therapeutic characteristics of RA patients treated with JAKi were recorded, including smoking habit and comorbidities.
Results: Three hundred and thirty consecutive RA patients were enrolled in the study. Among them, 50.3% patients had previously failed at least two biologic DMARDs. Risk factors for the use of JAKi were reported in 75.5% of patients, 41.5% of them were older than 65 years, 37.6% had smoked, while 48.8% had increased cardiovascular or cancer risk. Anticitrullinated peptide antibodies (ACPA) and combination therapy with conventional synthetic DMARDs were associated with a longer drug persistence and ACPA remained independently associated to a higher retention rate of JAKi also in the subgroup of difficult-to-treat patients.
Conclusions: In conclusion, our study supports the clinical effectiveness of JAKi in RA, even in the multi-failure subgroup of patients, where the risk/benefit ratio overcomes the safety risk. The presence of ACPA and the concurrent use of + cs-DMARD may increase the survival on JAKi in the long term.
目的我们旨在回顾性评估JAKi在RA患者中的保留率和停药原因,尤其是难以治疗的亚组:Janus 激酶抑制剂(JAKi)用于治疗类风湿性关节炎(RA)的疗效显著,即使在难以治疗的亚组患者中也是如此。口服监测研究发表后,JAKi 的标签被修改,建议老年患者以及有心血管事件和恶性肿瘤风险的患者不要使用。研究记录了接受JAKi治疗的RA患者的人口统计学、临床、血清学和治疗特征,包括吸烟习惯和合并症:研究共纳入了 330 名连续接受 JAKi 治疗的 RA 患者。其中,50.3%的患者之前至少使用过两种生物制剂DMARDs。75.5%的患者存在使用JAKi的风险因素,其中41.5%的患者年龄超过65岁,37.6%的患者吸烟,48.8%的患者心血管或癌症风险增加。抗瓜氨酸肽抗体(ACPA)和传统合成DMARDs联合治疗与更长的药物持续时间有关,在难以治疗的患者亚组中,ACPA仍与更高的JAKi持续率独立相关:总之,我们的研究支持JAKi在RA中的临床疗效,即使是在多失败亚组患者中,其风险/效益比也超过了安全风险。ACPA的存在以及同时使用+ cs-DMARD可能会提高JAKi的长期存活率。
期刊介绍:
Clinical and Experimental Rheumatology is a bi-monthly international peer-reviewed journal which has been covering all clinical, experimental and translational aspects of musculoskeletal, arthritic and connective tissue diseases since 1983.