目的 随访评估依那西普和传统合成改变病情抗风湿药（conventional synthetic disease modifying anti-rheumatic drugs，csDMARDs）序贯治疗强直性脊柱炎（ankylosing spondylitis，AS）的药物组合方案治疗轻中度AS的中期疗效。 方法 纳入南方医院2017~2018年确诊的轻中度AS患者64例，疾病活动期短期选用依那西普，疾病缓解期改用csDMARDs药物组合口服维持。分别于治疗前，治疗后3、6、12个月评估临床缓解率，并应用BASFI、BASDAI、SQOL-AS量表评价治疗效果。 结果 随访3、6、12个月，Patient Global、BASFI、BASDAI及ASDAS-CRP评分，CRP及ESR值均下降（P<0.05），SQOL-AS评分提高（P<0.05）。随访终点分别有85.9%、79.7%的患者达到ASAS 20、ASAS 40缓解标准。随访期间无结核、机会感染、肿瘤发生。 结论 对于轻中度AS，依那西普和csDMARDs序贯组合方案展示了良好的中期疗效，有望成为低收入AS患者的替代治疗方案。
Objective To evaluate etanercept and conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) in treating ankylosing spondylitis (AS) and its mid-term therapeutic effect among mild-to-moderate AS patients. Methods Sixty-four patients diagnosed with mild-to-moderate AS treating in our department from 2017 to 2018 were enrolled. Etanercept was used in the short term during the active stage of the disease, and csDMARDs combination was used for oral administration during the remission stage. Clinical remission rate was assessed before treatment, 3, 6 and 12 months after treatment. Tthe therapeutic effect was evaluated by BASFI, BASDAI and SQOL-AS scales. Results Patients Global, BASFI, BASDAI and ASDAS-CRP scores, CRP and ESR values decreased (P<0.05), while SQOL-AS scores increased (P<0.05) at 3, 6 and 12 months of follow-up. At the end of the follow-up, 85.9% and 79.7% of all enrolled patients achieved ASAS 20, ASAS 40 remission criteria, respectively. No tuberculosis, opportunistic infection or tumor occurred during the treatment. Conclusions For mild to moderate AS, the sequential combination of etanercept and csDMARDs shows satisfied mid-term therapeutic efficacy and expects to be an alternative treatment for those low-income AS patients.
[1] Maxwell LJ, Zochling J, Boonen A, et al. TNF-alpha inhibitors for ankylosing spondylitis[J]. Cochrane Database Syst Rev, 2015(4): Cd005468. DOI: 10.1002/14651858.CD005468.pub2.
[2] Ward MM, Deodhar A, Gensler LS, et al. 2019 Update of the American college of rheumatology/spondylitis association of America/spondyloarthritis research and treatment network recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis[J]. Arthritis Care Res (Hoboken), 2019, 71(10): 1285-1299. DOI: 10.1002/acr.24025.
[3] Tam LS, Wei JC. 2018 APLAR axial spondyloarthritis treatment recommendations[J]. Int J Rheum Dis, 2019, 22(3): 340-356. DOI: 10.1111/1756-185X.13510.
[4] Chan J, Gladman D. Oral treatment options for AS and PsA: DMARDs and small-molecule inhibitors[J]. Best Pract Res Clin Rheumatol, 2018, 32(3): 415-426. DOI: 10.1016/j.berh.2018.08.003.
[5] Linden SVD, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis[J]. Arthritis Rheum, 1984, 27(4): 361-368. DOI: 10.1002/art.1780270401.
[6] Smolen JS, Braun J, Dougados M, et al. Extended report: treating spondyloarthritis, including ankylosing spondylitis and psoriatic arthritis, to target: recommendations of an international task force[J]. Ann Rheum Dis, 2014, 73(1): 6. DOI: 10.1136/annrheumdis-2013-203419.
[7] Braun J, Van dHB, Irene E, et al. Clinical efficacy and safety of etanercept versus sulfasalazine in patients with ankylosing spondylitis: a randomized, double-blind trial[J]. Arthritis Rheum, 2011, 63(6): 1543. DOI: 10.1002/art.30223.
[8] Kádár G, Balázs E, Soós B, et al. Disease activity after the discontinuation of biological therapy in inflammatory rheumatic diseases[J]. Clin Rheumatol, 2014, 33(3): 329-333. DOI: 10.1007/s10067-014-2508-3.
[9] Osman MS, Maksymowych WP. An update on the use of tumor necrosis factor alpha inhibitors in the treatment of ankylosing spondylitis[J]. Expert Rev Clin Immunol, 2017, 13(2): 125-131. DOI: 10.1080/1744666X.2016.1218761.
[10]Tong Q, Cai Q, De MT, et al. Adverse events of anti-tumor necrosis factor α therapy in ankylosing spondylitis[J]. Plos One, 2015, 10(3): e0119897. DOI: 10.1371/journal.pone.0119897.
[11]Strand V, Balsa A, Al-Saleh J, et al. Immunogenicity of biologics in chronic inflammatory diseases: a systematic review[J]. BioDrugs, 2017, 31(4): 299-316. DOI: 10.1007/s40259-017-0231-8.
[12]Steiman AJ, Pope JE, Thiessen-Philbrook H, et al. Non-biologic disease-modifying antirheumatic drugs (DMARDs) improve pain in inflammatory arthritis (IA): a systematic literature review of randomized controlled trials[J]. Rheumatol Int, 2013, 33(5): 1105-1120. DOI: 10.1007/s00296-012-2619-6.
[13]Yu HC, Lu MC, Huang KY, et al. Sulfasalazine treatment suppresses the formation of HLA-B27 heavy chain homodimer in patients with ankylosing spondylitis[J]. Int J Mol Sci, 2015, 17(1): 46. DOI: 10.3390/ijms17010046.
[14]Relas H, Kautiainen H, Puolakka K, et al. Survival of disease-modifying antirheumatic drugs used as the first antirheumatic medication in the treatment of ankylosing spondylitis in Finland. A nationwide population-based register study[J]. Clin Rheumatol, 2014, 33(8): 1135-1138. DOI: 10.1007/s10067-014-2700-5.
[15]O'Dell JR, Leff R, Paulsen G, et al. Treatment of rheumatoid arthritis with methotrexate and hydroxychloroquine, methotrexate and sulfasalazine, or a combination of the three medications: Results of a two-year, randomized, double-blind, placebo-controlled trial[J]. Arthritis Rheum, 2002, 46(5): 1164. DOI: 10.1002/art.10228.
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