与肿瘤坏死因子抑制剂相比,Janus 激酶抑制剂和白细胞介素-17 抑制剂的药物存活时间更短的真实世界轴性脊柱关节炎患者队列分析--来自 RHADAR 网络的回顾性分析。

IF 3.2 3区 医学 Q2 RHEUMATOLOGY Rheumatology International Pub Date : 2024-10-01 Epub Date: 2024-08-13 DOI:10.1007/s00296-024-05671-9
Patrick-Pascal Strunz, Matthias Englbrecht, Linus Maximilian Risser, Torsten Witte, Matthias Froehlich, Marc Schmalzing, Michael Gernert, Astrid Schmieder, Peter Bartz-Bazzanella, Cay von der Decken, Kirsten Karberg, Georg Gauler, Patrick Wurth, Susanna Späthling-Mestekemper, Christoph Kuhn, Wolfgang Vorbrüggen, Johannes Heck, Martin Welcker, Stefan Kleinert
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引用次数: 0

摘要

近年来,Janus 激酶抑制剂(JAKi)与肿瘤坏死因子抑制剂(TNFi)和白细胞介素(IL)-17 抑制剂(IL-17i)一起被批准为治疗中重度轴性脊柱关节炎(axSpA)的改变病情抗风湿药(DMARD)。自 JAKi 获批以来,还没有在实际门诊情况下对 axSpA 患者的药物存活率进行过深入研究。我们的目的是根据作用模式(MoA)分析三种药物在德国 axSpA 门诊病人中的持续率。我们对 RHADAR 数据库中 2015 年 1 月至 2023 年 10 月期间新开始 TNFi、IL-17i 或 JAKi 治疗的 axSpA 患者进行了回顾性分析。分析包括 Kaplan-Meier 曲线和调整后的停药 Cox 回归。报告了1222例新的生物DMARD(TNFi [n = 954]、IL-17i [n = 190])或JAKi(n = 78)治疗。TNFi的中位药物存活期为31个月,IL-17i为25个月,JAKi为18个月。TNFi、IL-17i和JAKi相应的2年药物存活率分别为79.6%、72.6%和62.8%。JAKi的停药概率明显高于TNFi(HR 1.91 [95% CI 1.22-2.99]),IL-17i的停药概率也明显高于TNFi(HR 1.43 [95% CI 1.02-2.01]),这可能与TNFis更频繁地被用作一线疗法有关。IL-17i和JAKi的停药概率相似。在所有MoA的大多数病例中,原发性无应答是停药的原因。在德国axSpA门诊患者中,TNFi治疗的持续时间可能长于JAKi和IL-17i,这可能与JAKi治疗或IL-17i治疗的axSpA患者病情更严重或更难治有关。
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Analysis of the shorter drug survival times for Janus kinase inhibitors and interleukin-17 inhibitors compared with tumor necrosis factor inhibitors in a real-world cohort of axial spondyloarthritis patients - a retrospective analysis from the RHADAR network.

In recent years Janus kinase inhibitors (JAKi) have joined tumor necrosis factor inhibitors (TNFi) and interleukin (IL)-17 inhibitors (IL-17i) as approved disease modifying anti-rheumatic drugs (DMARD) for moderate to severe forms of axial spondyloarthritis (axSpA). Drug survival in axSpA patients has not been well studied in a real-world outpatient scenario since the approval of JAKi. We aimed to analyze the three drug classes based on modes of actions (MoA) for their persistence rates among German axSpA outpatients. A retrospective analysis of the RHADAR database for axSpA patients with a new initiation of TNFi, IL-17i, or JAKi treatment between January 2015 and October 2023 was conducted. Analyses included Kaplan-Meier curves and adjusted Cox regressions for drug discontinuation. 1222 new biological DMARD (TNFi [n = 954], IL-17i [n = 190]) or JAKi (n = 78) treatments were reported. The median drug survival was 31 months for TNFi, 25 for IL-17i, and 18 for JAKi. The corresponding 2-year drug survival rate was 79.6%, 72.6%, and 62.8% for TNFi, IL-17i, and JAKi, respectively. The probability for discontinuation for JAKi was significantly higher compared with TNFi (HR 1.91 [95% CI 1.22-2.99]) as well as for IL-17i compared with TNFi (HR 1.43 [95% CI 1.02-2.01]), possibly related to more frequent use of TNFis as first-line therapy. IL-17i and JAKi discontinuation probabilities were similar. Primary non-response was the reason for drug discontinuation in most cases across all MoA. TNFi treatment might persist longer than JAKi and IL-17i in German axSpA outpatients, possibly related to more severe or refractory disease in patients with JAKi-treated or IL-17i-treated axSpA.

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来源期刊
Rheumatology International
Rheumatology International 医学-风湿病学
CiteScore
7.30
自引率
5.00%
发文量
191
审稿时长
16. months
期刊介绍: RHEUMATOLOGY INTERNATIONAL is an independent journal reflecting world-wide progress in the research, diagnosis and treatment of the various rheumatic diseases. It is designed to serve researchers and clinicians in the field of rheumatology. RHEUMATOLOGY INTERNATIONAL will cover all modern trends in clinical research as well as in the management of rheumatic diseases. Special emphasis will be given to public health issues related to rheumatic diseases, applying rheumatology research to clinical practice, epidemiology of rheumatic diseases, diagnostic tests for rheumatic diseases, patient reported outcomes (PROs) in rheumatology and evidence on education of rheumatology. Contributions to these topics will appear in the form of original publications, short communications, editorials, and reviews. "Letters to the editor" will be welcome as an enhancement to discussion. Basic science research, including in vitro or animal studies, is discouraged to submit, as we will only review studies on humans with an epidemological or clinical perspective. Case reports without a proper review of the literatura (Case-based Reviews) will not be published. Every effort will be made to ensure speed of publication while maintaining a high standard of contents and production. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1964 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted.
期刊最新文献
Acknowledgement to referees. Séraphin (1747-1800), "the facetious hunchback": How ankylosing spondylitis contributed to the success of his shadow puppet theatre. A comparison of comorbidities and their risk factors prevalence across rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis with focus on cardiovascular diseases: data from a single center real-world cohort. COVID-19 vaccination-related delayed adverse events among people with rheumatoid arthritis: results from the international COVAD survey. Uncovering the alterations in extrinsic foot muscle mechanical properties and foot posture in fibromyalgia: a case-control study.
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