寻找预测强直性脊柱炎患者接受3次infliximab治疗后10周病情改善及复发的指标

ASAS20 at week 2 predicts subsequent improvement as well as the rate of relapse of ankylosing spondylitis infused with three pulses of infliximab

目的在接受3次infliximab治疗的强直性脊柱炎(AS)患者中寻找早期临床指标,用以预测该患者的病情能否于治疗10周时明显改善,或于停止治疗后仍能维持较长的缓解期。方法63例AS患者分别于0、2、6周接受5mg/kg的infliximab静脉注射治疗,并于每次注射前和第10周对患者进行评价。在治疗结束后对患者进行电话随访,直至其疾病活动度超过基线值的60%。此时可看作患者病情复发。对基线期以及第2周的各种临床指标进行分析,评价其能否预测第10周的病情改善情况,或能否预测病情复发的时间。用受试者工作特征曲线对曲线下面积(AUC)进行计算,AUC超过0.75时认为该指标具预测价值。结果基线期的各种指标均不具备预测价值。第2周的强直性脊柱炎国际工作组评价标准(ASAS 20)值不仅能预测第10周的临床改善情况,还可预测停药后病情缓解期的长短。结论AS患者对注射1次infliximab的临床反应是后续infliximab治疗反应以及停药后病情复发情况的最佳预测指标。

Objective To evaluate the clinical parameters that can predict whether a patient can get significant improvement at the 10th week, or whether a patient can have an extended length of remission after discontinuing the infusion in ankylosing spondylitis （AS） patients treated with three standard infusions of infliximab. Methods Sixty-three AS patients were given three infusions of 5 mg/kg of infliximab at week 0, 2 and 6; and were evaluated serially before each infusion and week 10. Afterwards, patients were followed by telephone interview until their disease activity was ≥60% of the baseline level. At that point, disease was considered to relapse. Clinical parameters at baseline as well as at week 2 were used to identify factors which might predict an improvement at week 10, or predict a delayed relapse. A predictor was regarded as being useful if the area under the curve （AUC） more than 0.75 when analyzed by receiver operator calculations （ROC）. Results No parameters at baseline have sufficient predictive value. However, ASAS20 （Assessment in Ankylosing Spondylitis International working Group criteria） at week 2 predicts improvement at week 10, and also duration of remission after discontinuing the infliximab at week 6. Conclusion The response to one pulse of infliximab is the best predictor of subsequent response as well as rate of relapse after discontinuing the infliximab.