Ann Rheum Dis：当使用一种TNFi治疗银屑病关节炎无效时应换用其他作用机制药物

　　挪威一项研究表明，在银屑病关节炎患者中，因使用一种肿瘤坏死因子抑制剂（TNFi）无效或不耐受而转换为第二种TNFi者的治疗反应率仅为20%～40%。这提示，当对一种TNFi治疗无效或不耐受时，应选择其他作用机制药物，而非第二种TNFi。该论文4月5日在线发表于《风湿病年鉴》（Ann Rheum Dis）杂志。

　　该观察性研究中，分别纳入TNFi持续应用者和因无效或不耐受转换为第二种TNFi应用者（即转换者）344例和95例。

　　结果为，与持续应用者相比，转换者的治疗反应性显著较差[达美国风湿病学会50%改善标准（ACR50）者：22.5%对40.0%；28个关节疾病活动性评分（DAS28）达到缓解者：28.2%对54.1%]。与对第一种TNFi的反应性相比，转换者对第二种TNFi的反应性有降低趋势。与总的使用第一种TNFi者（包括持续应用者和转换者）相比，转换者估计的3年药物生存率显著较低（36%对57%）。

与银屑病相关的拓展阅读：

• ARD：银屑病关节炎临床表现存性别差异
• Ann Rheum Dis：银屑病关节炎心血管风险呈上升趋势
• 阿达木单抗或为肥胖银屑病患者最佳抗TNF药物
• JAAD：银屑病患者要预防心血管疾病
• ECS:银屑病或是糖尿病的危险因素 更多信息请点击：有关银屑病更多资讯

Switching between TNF inhibitors in psoriatic arthritis: data from the NOR-DMARD study
Background
Tumour necrosis factor inhibitors (TNFi) are efficacious in patients with psoriatic arthritis (PsA), but some patients do not respond or do not tolerate their first TNFi, and are switched to a different TNFi. Evidence supporting this practice is limited, and we wanted to investigate the effectiveness of switching to a second TNFi.
Material and methods
From a longitudinal observational study (LOS) we selected patients with PsA who were starting their first TNFi, and identified patients who had switched to a second TNFi (‘switchers’). Three-month responses and 3-year drug-survival were compared between switchers and non-switchers, and within switchers.
Results
Switchers (n=95) receiving their second TNFi had significantly poorer responses compared with non-switchers (n=344) (ACR50 response: 22.5% vs 40.0%, DAS28 remission: 28.2% vs 54.1%). There was a trend towards poorer responses to the second TNFi compared with the first TNFi within switchers. Estimated 3-year drug-survival was 36% for the second TNFi compared with 57% for the first TNFi overall.
Conclusions
20–40% of patients had a response on a second TNFi after having failed one TNFi in this LOS. This observation highlights the need for treatments with other mechanisms of action than TNF inhibition in patients with PsA.