托法替布治疗难治性类风湿关节炎的分析

The clinical efficacy and safety of tofacitinib for difficult-to-treat rheumatoid arthritis:A retrospective case study

目的观察托法替布对难治性类风湿关节炎的临床疗效和安全性。方法回顾性分析兰州大学第二医院风湿免疫科51例托法替布治疗难治性类风湿关节炎患者24周的疗效和安全性指标。收集托法替布治疗前和治疗4、12和24周的疾病活动性指标DAS28_(CRP)、DAS28_(ESR)、血沉(ESR)、C反应蛋白(CRP)、28个肿胀关节数、28个压痛关节数和VAS疼痛评分指标并分析改善情况,评估治疗前后血常规、肝肾功能等安全性指标的变化。结果托法替布治疗4、12和24周相比治疗前DAS28_(CRP)、DAS28_(ESR)、CRP、ESR、28个肿胀关节数、28个压痛关节数和VAS疼痛指数均明显下降(P<0.05);治疗12和24周相比治疗4周,DAS28_(CRP)、DAS28_(ESR)、28个肿胀关节数、28个压痛关节数和VAS疼痛指数均明显下降(P<0.05);治疗24周,既往未使用生物DMARDs患者DAS28_(CRP)的临床缓解达标率优于曾使用过的患者(82.35%vs.76.47%)。无血栓、重症感染和贫血不良事件发生。结论托法替布能有效改善难治性类风湿关节炎患者症状、体征和炎性指标,短期内可降低疾病活动度,安全性良好。

Objective To explore the clinical efficacy and safety of tofacitinib in the treatment of difficultto-treat rheumatoid arthritis(D2T-RA).Methods Fifty-one patients with D2T-RA who had received therapies with tofacitinib for 24 weeks were included into this study.Disease activity indicators including disease activity score 28 joint count-C-reactive protein(DAS28_(CRP)),disease activity score 28 joint count-erythrocyte sedimentation rate(DAS28_(ESR)),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),swollen joints count,tender joints count,visual analogue score(VAS)and safety indicators were observed prior to treatment initiation and at weeks 4,12,and 24 after Tofacitinib treatment.Results As compared with the baselines,DAS28_(CRP),DAS28_(ESR),CRP,ESR,swollen joints count,tender joints count and VAS were all significantly decreased at weeks 4,12 and 24 after tofacitinib treatment(P<0.05).As compared with 4 weeks of treatment,DAS28_(CRP),DAS28_(ESR),swollen joints count,tender joints count and VAS were all significantly decreased at weeks 12 and 24(P<0.05).The patients with no previous therapies with biologic DMARDs were more likely to achieve the RDA of DAS28_(CRP)than those with prior uses of DMARDs(82.35%vs.76.47%).No adverse events including thrombosis,severe infection,and anemia occurred.Conclusions Tofacitinib can effectively improve symptoms,signs,and inflammatory indexes,and rapidly reduce the disease activity of D2T RA in the short term.It also has a better safety.