目的:评估临床特征,预测因素,和矛盾反应(PR)的实用算法,特别是自相矛盾的牛皮癣(PP)。
方法:TReasure数据库,是一个基于网络的前瞻性观察队列,包括自2017年以来来自土耳其各地17个中心的类风湿关节炎(RA)和脊柱关节炎(SpA)患者。确定了位于队列中的队列研究和病例对照研究。
结果:评估了2867例RA和5316例SpA患者。发现第一种生物制剂在发生PR的136名患者中的60%(1.66%)引起PR。PR与生物学发作之间的中位时间间隔为12个月(范围1-132,平均21个月)。最常见的PP类型,占公关的92.6%,脓疱(60.3%)和掌足底(30.9%)。阿达木单抗(30.9%),英夫利昔单抗(19%),和依那西普(17.4%)是引起PP的最常见药物。在大多数PP患者的治疗中(73.2%),转换生物制剂受到青睐,其中肿瘤坏死因子抑制剂(TNFi)占46.03%,非TNFi占26.9%。最常选择的三种药物是依那西普(24.6%),苏金单抗(9.5%),和阿达木单抗(8.7%)。只有5.17%的患者切换到另一个TNFi显示进展。柳氮磺吡啶,RA对照组的羟氯喹和来氟米特使用比值比明显高于PP患者(p=0.033,OR=0.15;p=0.012OR=0.15;p=0.015,OR=0.13)。在含SpA的PP组中,吸烟者人数明显较高(p=0.003,OR:2.0,95%CI:1,05-3,81).
结论:与类效应不同,转用另一种TNFi的患者的反应良好.
The objectives of this study were to assess the clinical characteristics, predictive factors, and practical algorithms of paradoxical reactions (PRs), specifically paradoxical psoriasis (PP).
The TReasure database is a web-based prospective observational cohort comprised of patients with RA and SpA from 17 centres around Turkey since 2017. A cohort study and a case-control study nestled within the cohort were identified.
In total, 2867 RA and 5316 SpA patients were evaluated. The first biologic agent was found to have caused PRs in 60% of the 136 patients (1.66%) who developed the PRs. The median time interval between the PRs and biological onset was 12 months (range 1-132 months, mean 21 months). The most common types of PP, constituting 92.6% of PRs, were pustular (60.3%) and palmoplantar (30.9%). Adalimumab (30.9%), infliximab (19%) and etanercept (17.4%) were the most common agents causing the PP. In the treatment of most PP patients (73.2%), switching biologic agents was favoured, with TNF inhibitor (TNFi) chosen in 46.03% and non-TNFi in 26.9% of cases. The three most frequently selected drugs were etanercept (24.6%), secukinumab (9.5%) and adalimumab (8.7%). Only 5.17% of patients who switched to another TNFi showed progression. The odds ratios (s) for SSZ, HCQ, and LEF use were significantly higher in RA controls than in PP patients (P = 0.033, OR = 0.15; P = 0.012, OR = 0.15; and P = 0.015, OR = 0.13, respectively). In the PP group with SpA, the number of smokers was significantly higher (P = 0.003, OR: 2.0, 95% CI: 1.05, 3.81).
Contrary to expectations based on earlier research suggesting that paradoxical reactions develop with the class effect of biological agents, the response of patients who were shifted to another TNFi was favourable.