NEJM:托法替尼治疗的类风湿性关节炎患者心血管疾病和癌症风险

2022-01-27 网络 网络

在心血管风险人群中比较了托法替尼与TNF抑制剂的联合剂量的疗效,托法替尼组发生MACE和癌症的风险更高,托法替尼更常发生一些不良事件。

与肿瘤坏死因子(TNF)抑制剂相比,托法替尼会增加血脂水平和癌症风险。因此,有必要针对类风湿性关节炎患者的主要不良血管事件(MACE)和癌症发生情况开展试验。

近日,顶级医学期刊NEJM上发表了一篇研究文章,研究人员进行了一项随机、开放标签、非劣效性、授权的、安全性终点试验。该研究纳入了接受甲氨蝶呤治疗的活动性类风湿关节炎患者,这些患者年龄在50岁或以上,并且至少有一个额外的心血管危险因素。患者以1:1:1的比例随机分配接受每日两次5 mg或10 mg的托法替尼或TNF抑制剂治疗。

该研究的共同主要终点是判定的MACE和癌症,不包括非黑色素瘤皮肤癌。如果与TNF抑制剂相比,联合托法替尼剂量的风险比两侧95%置信区间的上限小于1.8,则表明托法替尼的非劣效性。

该研究共有1455名患者接受了每日两次5mg的托法替尼,1456名患者接受了每日两次10mg的托法替尼,1451名患者接受了TNF抑制剂治疗。在4.0年的中位随访期间,托法替尼联合给药组的MACE和癌症发生率(分别为3.4%[98例患者]和4.2%[122例患者])高于TNF抑制剂组(2.5%[37例患者]和2.9%[42例患者])。MACE的风险比为1.33(95%置信区间[CI]为0.91至1.94),癌症的风险比为1.48(95%CI为1.04至2.09);未发现托法替尼的非劣效性。托法替尼组经裁定的机会性感染(包括带状疱疹和肺结核)、所有带状疱疹(非严重和严重)和经裁定的非黑色素瘤皮肤癌的发生率均高于TNF抑制剂。所有三组的疗效相似,从第2个月开始改善,一直持续到试验完成。

由此可见,在心血管风险人群中比较了托法替尼与TNF抑制剂的联合剂量的疗效,托法替尼组发生MACE和癌症的风险更高,托法替尼更常发生一些不良事件。

原始出处:
 
Steven R. Ytterberg,et al.Cardiovascular and Cancer Risk with Tofacitinib in Rheumatoid Arthritis.NEJM.2022.https://www.nejm.org/doi/full/10.1056/NEJMoa2109927

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    2022-03-07 医者仁者

    国内翻译为#托法替布#的更多

    0

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    2022-03-07 医者仁者

    #托法替尼#这类靶向药物,在大样本下,可能仍然存在一定的风险

    0

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    2022-01-29 lmm397
  4. [GetPortalCommentsPageByObjectIdResponse(id=1200138, encodeId=dd8c12001387d, content=国内翻译为<a href='/topic/show?id=d15b546e9f7' target=_blank style='color:#2F92EE;'>#托法替布#</a>的更多, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54679, encryptionId=d15b546e9f7, topicName=托法替布)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=医者仁者, createdTime=Mon Mar 07 08:13:24 CST 2022, time=2022-03-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1200137, encodeId=8a13120013e19, content=<a href='/topic/show?id=e827546e83e' target=_blank style='color:#2F92EE;'>#托法替尼#</a>这类靶向药物,在大样本下,可能仍然存在一定的风险, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54678, encryptionId=e827546e83e, topicName=托法替尼)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=医者仁者, createdTime=Mon Mar 07 08:12:05 CST 2022, time=2022-03-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1266404, encodeId=a16a1266404f2, 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=37, 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=Sat Jan 29 01:18:14 CST 2022, time=2022-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1334351, encodeId=89b31334351f8, 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=37, 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=Sat Jan 29 01:18:14 CST 2022, time=2022-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1483749, encodeId=09411483e4925, content=<a href='/topic/show?id=55a6100826cc' target=_blank style='color:#2F92EE;'>#风湿性关节炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100826, encryptionId=55a6100826cc, topicName=风湿性关节炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5c237911872, createdName=ms1467340776200723, createdTime=Sat Jan 29 01:18:14 CST 2022, time=2022-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1499008, encodeId=3c681499008b6, content=<a href='/topic/show?id=bb6f89e145a' target=_blank style='color:#2F92EE;'>#血管疾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89714, encryptionId=bb6f89e145a, topicName=血管疾病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ccb99370406, createdName=andy2090, createdTime=Sat Jan 29 01:18:14 CST 2022, time=2022-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1188554, encodeId=704c118855409, content=很及时,很不错,感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=311984902, createdName=maotouying, createdTime=Thu Jan 27 11:16:56 CST 2022, time=2022-01-27, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1200138, encodeId=dd8c12001387d, content=国内翻译为<a href='/topic/show?id=d15b546e9f7' target=_blank style='color:#2F92EE;'>#托法替布#</a>的更多, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54679, encryptionId=d15b546e9f7, topicName=托法替布)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=医者仁者, createdTime=Mon Mar 07 08:13:24 CST 2022, time=2022-03-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1200137, encodeId=8a13120013e19, content=<a href='/topic/show?id=e827546e83e' target=_blank style='color:#2F92EE;'>#托法替尼#</a>这类靶向药物,在大样本下,可能仍然存在一定的风险, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54678, encryptionId=e827546e83e, topicName=托法替尼)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=医者仁者, createdTime=Mon Mar 07 08:12:05 CST 2022, time=2022-03-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1266404, encodeId=a16a1266404f2, 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=37, 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=Sat Jan 29 01:18:14 CST 2022, time=2022-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1334351, encodeId=89b31334351f8, 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=37, 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=Sat Jan 29 01:18:14 CST 2022, time=2022-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1483749, encodeId=09411483e4925, content=<a href='/topic/show?id=55a6100826cc' target=_blank style='color:#2F92EE;'>#风湿性关节炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100826, encryptionId=55a6100826cc, topicName=风湿性关节炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5c237911872, createdName=ms1467340776200723, createdTime=Sat Jan 29 01:18:14 CST 2022, time=2022-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1499008, encodeId=3c681499008b6, content=<a href='/topic/show?id=bb6f89e145a' target=_blank style='color:#2F92EE;'>#血管疾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89714, encryptionId=bb6f89e145a, topicName=血管疾病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ccb99370406, createdName=andy2090, createdTime=Sat Jan 29 01:18:14 CST 2022, time=2022-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1188554, encodeId=704c118855409, content=很及时,很不错,感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=311984902, createdName=maotouying, createdTime=Thu Jan 27 11:16:56 CST 2022, time=2022-01-27, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1200138, encodeId=dd8c12001387d, content=国内翻译为<a href='/topic/show?id=d15b546e9f7' target=_blank style='color:#2F92EE;'>#托法替布#</a>的更多, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54679, encryptionId=d15b546e9f7, topicName=托法替布)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=医者仁者, createdTime=Mon Mar 07 08:13:24 CST 2022, time=2022-03-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1200137, encodeId=8a13120013e19, content=<a href='/topic/show?id=e827546e83e' target=_blank style='color:#2F92EE;'>#托法替尼#</a>这类靶向药物,在大样本下,可能仍然存在一定的风险, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54678, encryptionId=e827546e83e, topicName=托法替尼)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=医者仁者, createdTime=Mon Mar 07 08:12:05 CST 2022, time=2022-03-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1266404, encodeId=a16a1266404f2, 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=37, 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=Sat Jan 29 01:18:14 CST 2022, time=2022-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1334351, encodeId=89b31334351f8, 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=37, 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=Sat Jan 29 01:18:14 CST 2022, time=2022-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1483749, encodeId=09411483e4925, content=<a href='/topic/show?id=55a6100826cc' target=_blank style='color:#2F92EE;'>#风湿性关节炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100826, encryptionId=55a6100826cc, topicName=风湿性关节炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5c237911872, createdName=ms1467340776200723, createdTime=Sat Jan 29 01:18:14 CST 2022, time=2022-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1499008, encodeId=3c681499008b6, content=<a href='/topic/show?id=bb6f89e145a' target=_blank style='color:#2F92EE;'>#血管疾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89714, encryptionId=bb6f89e145a, topicName=血管疾病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ccb99370406, createdName=andy2090, createdTime=Sat Jan 29 01:18:14 CST 2022, time=2022-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1188554, encodeId=704c118855409, content=很及时,很不错,感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=311984902, createdName=maotouying, createdTime=Thu Jan 27 11:16:56 CST 2022, time=2022-01-27, status=1, ipAttribution=)]
  7. [GetPortalCommentsPageByObjectIdResponse(id=1200138, encodeId=dd8c12001387d, content=国内翻译为<a href='/topic/show?id=d15b546e9f7' target=_blank style='color:#2F92EE;'>#托法替布#</a>的更多, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54679, encryptionId=d15b546e9f7, topicName=托法替布)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=医者仁者, createdTime=Mon Mar 07 08:13:24 CST 2022, time=2022-03-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1200137, encodeId=8a13120013e19, content=<a href='/topic/show?id=e827546e83e' target=_blank style='color:#2F92EE;'>#托法替尼#</a>这类靶向药物,在大样本下,可能仍然存在一定的风险, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54678, encryptionId=e827546e83e, topicName=托法替尼)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=医者仁者, createdTime=Mon Mar 07 08:12:05 CST 2022, time=2022-03-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1266404, encodeId=a16a1266404f2, 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=37, 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=Sat Jan 29 01:18:14 CST 2022, time=2022-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1334351, encodeId=89b31334351f8, 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=37, 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=Sat Jan 29 01:18:14 CST 2022, time=2022-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1483749, encodeId=09411483e4925, content=<a href='/topic/show?id=55a6100826cc' target=_blank style='color:#2F92EE;'>#风湿性关节炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100826, encryptionId=55a6100826cc, topicName=风湿性关节炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5c237911872, createdName=ms1467340776200723, createdTime=Sat Jan 29 01:18:14 CST 2022, time=2022-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1499008, encodeId=3c681499008b6, content=<a href='/topic/show?id=bb6f89e145a' target=_blank style='color:#2F92EE;'>#血管疾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89714, encryptionId=bb6f89e145a, topicName=血管疾病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ccb99370406, createdName=andy2090, createdTime=Sat Jan 29 01:18:14 CST 2022, time=2022-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1188554, encodeId=704c118855409, content=很及时,很不错,感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=311984902, createdName=maotouying, createdTime=Thu Jan 27 11:16:56 CST 2022, time=2022-01-27, status=1, ipAttribution=)]
    2022-01-27 maotouying

    很及时,很不错,感谢分享

    0

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