ACR2010_小剂量依那西普对达到缓解的AS患者有效

研究提示达到临床缓解的AS患者使用小剂量ETN有效，无疾病活动度增高。这是一种很有前景的方案，但需要更多研究加以证实。

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[1944] - Low Doses of Etanercept Can Be Effective in Ankylosing Spondylitis Patients Who Achieve Remission of the Disease.

Victoria Navarro Compán,Rafael Ariza Ariza,Carmen Vargas Lebrón,Blanca Hernández Cruz¹,Virginia Moreira Navarrete,Federico Navarro Sarabia. ¹Hospital universitario Virgen Macarena

Background: There is no evidence other than symptoms control to maintain the antiTNF therapy in patients with ankylosing spondylitis (AS). In this regard, low dose regimens could be considered in patients whose disease is clinically controlled. Moreover, the economic implications of this strategy can be important. However, although dose reduction can be common in clinical practice, the available data about it are scarce.
Objective: to explore the effectiveness of low dose of etanercept (ETN) in patients with ankylosing spondylitis (AS) who achieves a good control of their disease in daily clinical practice.
Methods: case series of AS patients treated with ETN. According to the judgment of the treating rheumatologist and patient´s preferences, a dose reduction was done in those patients who achieved a good control of their disease defined by BASDAI < 5 and C-reactive protein normal values. Descriptive statistics were calculated with mean, mode, median, ranges percents and lower and upper quartiles.
Results: 51 AS patients treated with ETN were identified and 16 of them (32%) were on dose reduction regimen.

Several regimens of dose reduction were used. Mean time receiving ETN before adjusting the dose was 17 ± 12 months. Mean follow up after dose change was 2 1±21 months. At this point all the patients in whom dose reduction was done remained in the low dose regimen. Median BASDAI (range) at starting the low dose regimen and 6 months later were 1.6 (0.9-2.4), and 1.4 (0.3-3.2), respectively. Median CRP values (range) at starting the low dose regimen and 6 months later were 1mg/l (0.1-2.8), and 1.3 mg/l (0.3-4.1), respectively. Other disease-related variables also remained unchanged. Patients with follow up at 12 and 24 months and longer remained in clinical remission with BASDAI values <2 and normal CRP values.

Conclusions: our data suggest that AS patients in clinical remission can use low doses of ETN without increasing disease activity. So, it can be a promising strategy but additional studies are needed to prove it.

小剂量依那西普对达到缓解的AS患者有效

Navarro-Compan V, et al. ACR 2010. Present No: 1944.

背景: AS患者持续使用TNF抑制剂的原因是为了控制症状。就此而言，小剂量TNF抑制剂可考虑用于疾病达到临床控制的患者。此外，此方案更为经济。尽管减量在临床工作中非常常见，但相关数据较少。

目的: 探讨在日常临床工作中，小剂量依那西普（ETN）对达到缓解的AS患者的疗效。

方法: 一组AS患者使用ETN治疗。根据医生判断和患者意愿，病情得到良好控制的患者可以将ETN减量，相关条件是：BASDAI<5、CRP正常。

结果: 共有51例AS患者使用ETN，其中16例（32%）采用减量方案。

^分组	^低剂量^ETN^{维持的病人}	^所有患者
^男性^{, %}	¹⁴^（^94%^）	⁴⁵^（^91%^）
^HLA-B27+, ^例数^{, %}	¹⁴^（^87%^）	⁴³^（^84%^）
^{外周关节炎}	³^（^19%^）	³⁶^（^71%^）
^葡萄膜炎^, ^例数^{, %}	⁵^（^31%^）	⁴¹^（^80%^）
^{骶髂关节炎}^, ^例数^{, %}	⁴^（^25%^）^II	¹²^（^24%^）^II
	¹⁰^（^62.5%^）^III	²⁰^（^39%^）^III
	²^（^12.5%^）^IV	¹⁹^（^37%^）^IV
^之前用过^DMARDs,^例数^{, %}	⁶^（^31%^）	³⁴^（^67%^）
	^{中位数（范围）}	^{中位数（范围）}
^年龄^, ^岁	^42.5^（^30.5-57^）	⁴⁴^（^32.53^）
^病程^, ^年	⁸^（^3.5-14.7^）	¹⁰^（^6.5-18^）
^BASDAI	^5.8^（^4.5-7.7^）	^6.2^（^4.7-7.9^）
^BASFI	^5.9^（^4.2-6.9^）	^6.5^（^5-8.1^）
^ESR	³⁴^（^16-72^）	²⁹^（^14-72^）
^CRP(mg/L)	^17.9^（^9.1-33.0^）	¹⁸^（^10-3.9^）
^PGA	⁵⁵^（^47-84^）	⁶²^（^50-87^）

采用数种减量方案。调整剂量前平均使用ETN 17±12个月。调整剂量后平均随访21±21个月。随访期内减量患者维持小剂量方案。开始小剂量方案及6个月后的平均BASDAI分别为1.6（0.9-2.4）和1.4（0.3-3.2），CRP均值分别为1mg/L（0.1-2.8）和1.3 mg/L（0.3-4.1）。其它疾病相关参数没有变化。随访12周、24周及更长时间，患者维持临床缓解，BASDAI<2且CRP正常。

结论: 研究提示达到临床缓解的AS患者使用小剂量ETN有效，无疾病活动度增高。这是一种很有前景的方案，但需要更多研究加以证实。