类风湿性关节炎(RA)是一种慢性自身免疫性疾病,显著影响患者的生活质量。虽然多年来治疗方案已经扩大,包括引入肿瘤坏死因子-α(TNFα)抑制剂(TNFi),优化这些代理人的退出策略仍然是一个挑战。
■本综述审查了当前关于RA中TNFi戒断策略的证据,关注影响戒断决定的因素,如疾病活动监测,治疗反应,患者特征,和生物标志物。进行了全面的文献检索,包括随机对照试验,观察性研究,和专家指南。RA的病理生理学,目前的药理学药物,并讨论了治疗对目标的策略,以提供对RA管理的整体理解。
■戒断策略可能适用于某些患者,请记住,有几个因素影响退出决定,包括治疗反应,疾病活动和监测,和患者特征。退出TNFi的决定必须平衡疾病发作和长期治疗相关不良反应的潜在风险。早期结合DMARDs和TNFi可以改善结果,支持缩减成本效益和预防耀斑战略。未来的方向,包括精准医学方法,以病人为中心的护理模式,和卫生经济学分析,建议进一步优化RA管理并改善患者预后。
UNASSIGNED: Rheumatoid arthritis (RA) is a chronic autoimmune disease that significantly impacts patients\' quality of life. While treatment options have expanded over the years, including the introduction of tumor necrosis factor-alpha (TNFα) inhibitors (TNFi), optimizing withdrawal strategies for these agents remains a challenge.
UNASSIGNED: This review examines the current evidence on TNFi withdrawal strategies in RA, focusing on factors influencing withdrawal decisions such as disease activity monitoring, treatment response, patient characteristics, and biomarkers. A comprehensive literature search was conducted, including randomized controlled trials, observational studies, and expert guidelines. The pathophysiology of RA, current pharmacological agents, and the treat-to-target strategy are discussed to provide a holistic understanding of RA management.
UNASSIGNED: Withdrawal strategies could be suitable for certain patients, keeping in mind that several factors influence withdrawal decisions, including treatment response, disease activity and monitoring, and patient characteristics. The decision to withdraw TNFi must balance the benefits against the potential risks of disease flare and long-term treatment-related adverse effects. Combining DMARDs and TNFi early improves outcomes, supporting tapering strategies for cost-effectiveness and flare prevention. Future directions, including precision medicine approaches, patient-centered care models, and health economics analyses, are proposed to further optimize RA management and improve patient outcomes.