全部 标题 作者
关键词 摘要

OALib Journal期刊
ISSN: 2333-9721
费用:99美元

查看量下载量

相关文章

更多...
华西医学  2015 

托珠单抗治疗难治性类风湿关节炎的临床观察

DOI: 10.7507/1002-0179.20150467, PP. 1633-1637

Keywords: 托珠单抗,类风湿关节炎,临床观察

Full-Text   Cite this paper   Add to My Lib

Abstract:

目的?探讨托珠单抗治疗活动性难治性类风湿关节炎(RRA)的短期临床疗效及安全性。方法?选择2013年10月-2014年10月使用托珠单抗治疗的RRA患者40例,给予托珠单抗8mg/kg,每4周输注1次,合并用药维持剂量不变。在基线水平,第1、4、12、16、24周和停用托珠单抗4、8周时分别评价临床和实验室指标。结果?在随访的各时间点患者RRA的各项指标均有一定改善,且随治疗时间的延长,各项指标呈进行性下降趋势。第1周时疼痛评分、红细胞沉降率、C反应蛋白、28个关节疾病活动度评分(DAS28)和健康评估问卷(HAQ)就有明显下降(P<0.05),第12周时所有患者的炎症指标已降至正常范围,62.9%(22/35)的患者达到美国风湿病学会制定的疾病活动度缓解20%,28.6%(10/35)的患者达到美国风湿病学会制定的疾病活动度缓解50%(ACR50)。第24周时12例未停药患者均达到低疾病活动度(DAS28评分≤3.2分)及ACR50。HAQ评分在治疗第24周时最低(3.1±1.6)分,与基线时的(20.2±6.7)分相比差异有统计学意义(P<0.01)。停用托珠单抗4周时,所有指标回升不明显。停药8周时,除了肿胀关节数、C反应蛋白、DAS28和HAQ无明显反弹外,其余指标均较停药4周时有明显增加(P<0.01)。不良反应主要为肝功能异常和血脂升高,其次为白细胞减少。仅1例患者因不良反应停药。结论?托珠单抗对RRA的疗效确切、快速,安全性良好,停药后其疗效仍能维持4~8周。

References

[1]  10 Emery P, Keystone E, Tony HP, et al. IL-6 receptor inhibition with tocilizumab improves treatment outcomes in patients with rheumatoid arthritis refractory to anti-tumour necrosis factor biologicals: results from a 24-week multicentre randomised placebo-controlled trial[J]. Ann Rheum Dis, 2008, 67(11): 1516-1523.
[2]  11 Genovese MC, McKay JD, Nasonov EL, et al. Interleukin-6 receptor inhibition with tocilizumab reduces disease activity in rheumatoid arthritis with inadequate response to disease-modifying antirheumatic drugs: the tocilizumab in combination with traditional disease-modifying antirheumatic drug therapy study[J]. Arthritis Rheum, 2008, 58(10): 2968-2980.
[3]  12 Kremer JM, Fleischmann RM, Halland A, et al. Tocilizumab inhibits structural joint damage in rheumatoid arthritis patients with an inadequate response to methotrexate: the LITHE study[J]. Arthritis Rheum, 2008, 58(12): 4031.
[4]  13 史群, 赵岩, 鲍春德, 等. 托珠单抗联合改善病情抗风湿药治疗类风湿关节炎的多中心、随机、双盲、安慰剂对照临床研究[J]. 中华内科杂志, 2013, 52(4): 323-329.
[5]  1 Singh JA, Furst DE, Bharat A, et al. 2012 update of the 2008 American college of rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis[J]. Arthritis Care Res (Hoboken), 2012, 64(5): 625-639.
[6]  2 杨岫岩, 谢彤. 难治性类风湿性关节炎的治疗[J]. 广东医学, 2001, 22(10): 893-894.
[7]  3 Singh JA, Beg S, Lopez-Olivo MA. Tocilizumab for rheumatoid arthritis[J]. Cochrane Database Syst Rev, 2010 (7): CD008331.
[8]  4 Aletaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative[J]. Arthritis Rheum, 2010, 62(9): 2569-2581.
[9]  5 Md Yusof MY, Emery P. Targeting interleukin-6 in rheumatoid arthritis[J]. Drugs, 2013, 73(4): 341-356.
[10]  6 王永红, 王可丽, 许素琴, 等. 难治性类风湿关节炎临床特点分 析[J]. 中华风湿病学杂志, 2005, 5(9): 171.
[11]  7 Smolen JS, Landewé R, Breedveld FC, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update[J]. Ann Rheum Dis, 2014, 73(3): 492-509.
[12]  8 Fleischmann RM, Halland AM, Brzosko M, et al. Tocilizumab inhibits structural joint damage and improves physical function in patients with rheumatoid arthritis and inadequate responses to methotrexate: LITHE study 2-year results[J]. J Rheumatol, 2013, 40(2): 113-126.
[13]  9 Smolen JS, Beaulieu A, Rubbert-Roth A, et al. Effect of interleukin-6 receptor inhibition with tocilizumab in patients with rheumatoid arthritis (OPTION study): a double-blind, placebo-controlled, randomised trial[J]. Lancet, 2008, 371(9617): 987-997.

Full-Text

Contact Us

service@oalib.com

QQ:3279437679

WhatsApp +8615387084133