【medical-news】EULAR2009新闻：瑞典一项大型病例对照研究提示抗TNF治疗未能有效降低关节外受累的发生风险
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Clinical Science
10 Years of Biologics in RA: What Is the Long-Term Benefit for Patients?
Friday, 13:30–15:00
Hall A2
Extra-Articular RA Unchanged by TNF Inhibition
Anti–tumour necrosis factor therapy failed to cut the risk of extraarticular manifestations of rheumatoid arthritis in a case-control study with more than 25,000 patients.
Although anti- TNF therapy has been linked with a reduced risk for vasculitis in patients with rheumatoid arthritis, RA patients treated with anti-TNF agents appeared to have an increased risk for developing interstitial lung disease, judging from findings to be presented Friday by Dr. Carl Turesson.
The disparate effect of anti-TNF drugs on the incidence of vasculitis and interstitial lung disease in RA patients may result from TNF inhibitors’ distinct biologic effects on different organ manifestations of RA, suggested Dr. Turesson.
The findings were also surprising. “We expected a decrease in vasculitis and other severe extra-articular manifestations” based on prior findings in smaller studies and on animal studies, said Dr. Turesson, a rheumatology researcher at Malmö (Sweden) University Hospital who spoke in an interview with EULAR Congress News. “I am not sure there is a need for major changes [in RA treatment] based on the findings,” he added. “I think many rheumatologists are already hesitant about using TNF inhibitors in patients with RA-associated lung disease. Severe extra-articular RA is a relatively infrequent finding, but it is useful to physicians to have some idea of what serious disease complications may occur among patients treated with TNF inhibitors.”
The study included 67,208 patients with RA enrolled in the Swedish national registry of hospital admissions, outpatient visits, and early RA diagnosis in 1998-2005. The registry included 5,299 patients identified as receiving treatment with an anti-TNF drug based on their listing in the Swedish Biologics Register. Each of these patients was matched with four RA patients who were not treated with an anti-TNF drug and who were selected at random from the registries, a total of 21,084 control RA patients.
The study analyzed the incidence of any severe extra-articular manifestations, including vasculitis, interstitial lung disease, or serositis. Patients with a severe manifestation at baseline were excluded from the analysis.
The study identified a total of 122 patients with severe extra-articular manifestations, including 51 cases of interstitial lung disease, 48 cases of vasculitis, and 26 cases of serositis. (The total number of cases was 125 because some patients had more than one manifestation.) Comparing patients treated with an anti-TNF drug to the matched controls showed that overall anti-TNF treatment had no significant impact on the rate of severe extra-articular manifestations. The overall incidence was 0.21 cases per 100 patient-years.
Patients on an anti-TNF regimen had an 82% reduced relative incidence of vasculitis, compared with patients on other treatments, a statistically significant difference. Anti-TNF treatment also was linked with a similar (84%) relative drop in the rate of serositis, although this link was not statistically significant. But patients on an anti-TNF drug also had a 2.56-fold relative increased risk for developing interstitial lung disease that was statistically significant. The analysis also showed that patients on anti-TNF treatment who developed a severe extraarticular manifestation were older, with an average age of 64 years, compared with an average age of 58 years among those who had a manifestation without anti-TNF treatment.
Patients with a severe manifestation on an anti-TNF drug were also more likely to have a shorter disease duration and a higher level of disability at baseline.
“I do not think that the study was sufficiently powered to definitely disprove that there is an increased risk of severe extra-articular RA overall [with anti- TNF treatment], but based on the results, it is unlikely that there is a major increase,” Dr. Turesson said.
10 Years of Biologics in RA: What Is the Long-Term Benefit for Patients?
Friday, 13:30–15:00
Hall A2
Extra-Articular RA Unchanged by TNF Inhibition
Anti–tumour necrosis factor therapy failed to cut the risk of extraarticular manifestations of rheumatoid arthritis in a case-control study with more than 25,000 patients.
Although anti- TNF therapy has been linked with a reduced risk for vasculitis in patients with rheumatoid arthritis, RA patients treated with anti-TNF agents appeared to have an increased risk for developing interstitial lung disease, judging from findings to be presented Friday by Dr. Carl Turesson.
The disparate effect of anti-TNF drugs on the incidence of vasculitis and interstitial lung disease in RA patients may result from TNF inhibitors’ distinct biologic effects on different organ manifestations of RA, suggested Dr. Turesson.
The findings were also surprising. “We expected a decrease in vasculitis and other severe extra-articular manifestations” based on prior findings in smaller studies and on animal studies, said Dr. Turesson, a rheumatology researcher at Malmö (Sweden) University Hospital who spoke in an interview with EULAR Congress News. “I am not sure there is a need for major changes [in RA treatment] based on the findings,” he added. “I think many rheumatologists are already hesitant about using TNF inhibitors in patients with RA-associated lung disease. Severe extra-articular RA is a relatively infrequent finding, but it is useful to physicians to have some idea of what serious disease complications may occur among patients treated with TNF inhibitors.”
The study included 67,208 patients with RA enrolled in the Swedish national registry of hospital admissions, outpatient visits, and early RA diagnosis in 1998-2005. The registry included 5,299 patients identified as receiving treatment with an anti-TNF drug based on their listing in the Swedish Biologics Register. Each of these patients was matched with four RA patients who were not treated with an anti-TNF drug and who were selected at random from the registries, a total of 21,084 control RA patients.
The study analyzed the incidence of any severe extra-articular manifestations, including vasculitis, interstitial lung disease, or serositis. Patients with a severe manifestation at baseline were excluded from the analysis.
The study identified a total of 122 patients with severe extra-articular manifestations, including 51 cases of interstitial lung disease, 48 cases of vasculitis, and 26 cases of serositis. (The total number of cases was 125 because some patients had more than one manifestation.) Comparing patients treated with an anti-TNF drug to the matched controls showed that overall anti-TNF treatment had no significant impact on the rate of severe extra-articular manifestations. The overall incidence was 0.21 cases per 100 patient-years.
Patients on an anti-TNF regimen had an 82% reduced relative incidence of vasculitis, compared with patients on other treatments, a statistically significant difference. Anti-TNF treatment also was linked with a similar (84%) relative drop in the rate of serositis, although this link was not statistically significant. But patients on an anti-TNF drug also had a 2.56-fold relative increased risk for developing interstitial lung disease that was statistically significant. The analysis also showed that patients on anti-TNF treatment who developed a severe extraarticular manifestation were older, with an average age of 64 years, compared with an average age of 58 years among those who had a manifestation without anti-TNF treatment.
Patients with a severe manifestation on an anti-TNF drug were also more likely to have a shorter disease duration and a higher level of disability at baseline.
“I do not think that the study was sufficiently powered to definitely disprove that there is an increased risk of severe extra-articular RA overall [with anti- TNF treatment], but based on the results, it is unlikely that there is a major increase,” Dr. Turesson said.
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