阿巴西普治疗多种生物制剂治疗失败的类风湿关节炎1例

A case of treatment with abatacept to rheumatoid arthritis in which multiple biologics failed

临床上,难治性类风湿关节炎患者经多种不同作用机制免疫抑制剂治疗仍无法实现疾病缓解或低疾病活动度,生活质量长期受到极大影响。本文报道1例难治性类风湿关节炎患者,在使用甲氨蝶呤的基础上联合生物改善病情的抗风湿药物(disease-modifying anti-rheumatic drugs,DMARDs)或靶向合成DMARDs,历经托珠单抗、英夫利昔单抗、依那西普、托法替布的联用方案,但因不良反应或疗效不佳而治疗失败。最后采用阿巴西普成功控制病情活动,减轻炎症指标,患者反应良好,无明显不良反应。阿巴西普对该例类风湿关节炎的治疗方案和诊疗过程,可能为多种生物制剂治疗失败的难治性类风湿关节炎患者治疗提供一定的临床治疗建议。

After immunosuppressive therapy with various mechanisms of action,patients with refractory rheumatoid arthritis still cannot achieve disease remission or low disease activity.The quality of life of these patients will be greatly affected for a long time.This article reports the therapeutic regimen failure of a patient with refractory rheumatoid arthritis,which is combination of biological disease-modifying anti-rheumatic drugs(DMARDs)or targeted synthetic DMARDs on the basis of methotrexate,followed by the combined regimen of tocilizumab,infliximab,etanercept and tofacitinib.The treatment failed due to adverse reactions or poor efficacy.Finally,abatacept successfully controlled disease activity and reduced the inflammatory indicators,and the patient responded well with no obvious adverse reactions.Abatacept provides some clinical suggestions for the treatment of patients with refractory rheumatoid arthritis who undergos failure of multiple biological agents.