Lancet:维持低剂量糖皮质激素治疗对低疾病活动度的类风湿关节炎患者症状控制更为有效

2020-07-25 MedSci原创 MedSci原创

研究认为,对于使用托珠单抗和至少24周的糖皮质激素治疗达到低疾病活动度的类风湿关节炎患者,继续维持每天5mg的糖皮质激素治疗对疾病的控制效果优于逐渐减少糖皮质激素治疗方案

类风湿性关节炎因长期使用糖皮质激素药物会产生多种不良反应,近日研究人员考察了一种逐渐减少口服糖皮质激素方案对类风湿性关节炎的治疗效果。
 
SEMIRA研究中,患有类风湿关节炎的成人患者在每天接受5-15毫克的托珠单抗治疗基础上,使用小剂量的糖皮质激素(泼尼松5mg),持续24周以上,并且处于稳定的较低疾病活性状态,在分组前4-6周和当天,28个关节的疾病活动评分-红细胞沉降率(DAS28-ESR)不超过3.2。上述患者随机接受持续的泼尼松5mg/天治疗,持续24周,或在第16周逐渐减少泼尼松用量,直至达到停药。在24周的研究中,所有患者都接受了托珠单抗(每周皮下注射162mg,或每4周静脉注射8mg/kg)治疗。研究的主要结果是从基线检查到第24周的平均DAS28-ESR变化的差异。
 
259名患者参与研究,女性占77%。128例接受维持性泼尼松方案的患者中,疾病活动性控制效果优于131名接受泼尼松减量方案的患者:泼尼松减量方案组从基线检查到第24周,DAS28-ESR的估计平均变化为0.54,泼尼松维持方案组为-0.08。泼尼松维持组99例患者治疗成功(定义为24周低疾病活动,且24周没有类风湿关节炎发作,无证实的肾上腺功能不全),而泼尼松减量组85例患者成功(相对风险0.83)。泼尼松减量组7例患者出现重度不良事件,泼尼松维持组4例(5 vs 3%),无患者出现症状性肾上腺功能不全。
 
研究认为,对于使用托珠单抗和至少24周的糖皮质激素治疗达到低疾病活动度的类风湿关节炎患者,继续维持每天5mg的糖皮质激素治疗对疾病的控制效果优于逐渐减少糖皮质激素治疗方案。
 
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    2021-03-21 455568866

    疗效是好些,其它副作用也得考虑

    0

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    2020-08-18 howi
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  5. 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  6. 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  7. 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topicList=[TopicDto(id=70693, encryptionId=7617e0693b6, topicName=疾病活动度)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d64f419, createdName=qindq, createdTime=Sat Dec 26 22:11:04 CST 2020, time=2020-12-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1924398, encodeId=1e5e1924398d5, content=<a href='/topic/show?id=34a8651660b' target=_blank style='color:#2F92EE;'>#活动度#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65166, encryptionId=34a8651660b, topicName=活动度)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/kbRUeosenzlejlNGWXdWjSYhBKL1QYGQwfehJOkMXHiavh5wl7pKeju5Kcxdvr50ic6FWML3x6NMCxhG1bOaVjyA/132, createdBy=20872500216, createdName=ms4657536712156177, createdTime=Sat Nov 21 08:11:04 CST 2020, time=2020-11-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1266217, 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2020, time=2020-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1334252, encodeId=e02f1334252e5, content=<a href='/topic/show?id=5306e6164b6' target=_blank style='color:#2F92EE;'>#类风湿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76164, encryptionId=5306e6164b6, topicName=类风湿)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eq2AGzrugK9ZUjU3eJxzM901ophWib0xJDrSicy49ibWl3zB5pbDto7eoR6tnzwOiaKdbq1a8PcbYFFrw/132, createdBy=6ff22500098, createdName=ms4964546379600229, createdTime=Mon Jul 27 01:11:04 CST 2020, time=2020-07-27, status=1, ipAttribution=)]
  8. 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createdBy=a9de34, createdName=shenxlcyp, createdTime=Sun Mar 21 02:11:04 CST 2021, time=2021-03-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1756099, encodeId=d73a1e56099c2, content=<a href='/topic/show?id=78e1e06924a' target=_blank style='color:#2F92EE;'>#疾病活动#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70692, encryptionId=78e1e06924a, topicName=疾病活动)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=57fa37069463, createdName=xue8614, createdTime=Tue Mar 02 07:11:04 CST 2021, time=2021-03-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1799453, encodeId=88d51e99453bb, content=<a href='/topic/show?id=7617e0693b6' target=_blank style='color:#2F92EE;'>#疾病活动度#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70693, encryptionId=7617e0693b6, topicName=疾病活动度)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d64f419, createdName=qindq, createdTime=Sat Dec 26 22:11:04 CST 2020, time=2020-12-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1924398, encodeId=1e5e1924398d5, content=<a href='/topic/show?id=34a8651660b' target=_blank style='color:#2F92EE;'>#活动度#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65166, encryptionId=34a8651660b, topicName=活动度)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/kbRUeosenzlejlNGWXdWjSYhBKL1QYGQwfehJOkMXHiavh5wl7pKeju5Kcxdvr50ic6FWML3x6NMCxhG1bOaVjyA/132, createdBy=20872500216, createdName=ms4657536712156177, createdTime=Sat Nov 21 08:11:04 CST 2020, time=2020-11-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1266217, encodeId=8bc3126621e42, content=<a href='/topic/show?id=57a53011364' target=_blank style='color:#2F92EE;'>#关节炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30113, encryptionId=57a53011364, topicName=关节炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f90281, createdName=lmm397, createdTime=Mon Jul 27 01:11:04 CST 2020, time=2020-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1307435, encodeId=515b130e43532, content=<a href='/topic/show?id=b1d766836e4' target=_blank style='color:#2F92EE;'>#激素治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=66836, encryptionId=b1d766836e4, topicName=激素治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bfa6343, createdName=aliceclz, createdTime=Mon Jul 27 01:11:04 CST 2020, time=2020-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1334252, encodeId=e02f1334252e5, content=<a href='/topic/show?id=5306e6164b6' target=_blank style='color:#2F92EE;'>#类风湿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76164, encryptionId=5306e6164b6, topicName=类风湿)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eq2AGzrugK9ZUjU3eJxzM901ophWib0xJDrSicy49ibWl3zB5pbDto7eoR6tnzwOiaKdbq1a8PcbYFFrw/132, createdBy=6ff22500098, createdName=ms4964546379600229, createdTime=Mon Jul 27 01:11:04 CST 2020, time=2020-07-27, status=1, ipAttribution=)]
    2020-07-27 lmm397
  9. 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2020, time=2020-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1334252, encodeId=e02f1334252e5, content=<a href='/topic/show?id=5306e6164b6' target=_blank style='color:#2F92EE;'>#类风湿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76164, encryptionId=5306e6164b6, topicName=类风湿)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eq2AGzrugK9ZUjU3eJxzM901ophWib0xJDrSicy49ibWl3zB5pbDto7eoR6tnzwOiaKdbq1a8PcbYFFrw/132, createdBy=6ff22500098, createdName=ms4964546379600229, createdTime=Mon Jul 27 01:11:04 CST 2020, time=2020-07-27, status=1, ipAttribution=)]
  10. 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